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Sample records for coronary microvascular reactivity

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

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    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 ...

  2. 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.)

  3. 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

  4. Coronary microvascular obstruction in acute myocardial infarction.

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    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.

  5. Skin microvascular reactivity in patients with hypothyroidism.

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    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.

  6. 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

  7. 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.

  8. Coronary microvascular dysfunction in overt diabetic cardiomyopathy

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    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.

  9. 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.

  10. 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...

  11. 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...

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

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    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.

  13. Obesity is associated with lower coronary microvascular density.

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    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.

  14. 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...

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

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    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....

  16. Microvascular reactivity during sympathetic stimulations in Raynaud's phenomenon.

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    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.

  17. 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...

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

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    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...

  19. 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

  20. 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...

  1. 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.

  2. 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.

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

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    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

  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. The effect of exercise training on cutaneous microvascular reactivity: A systematic review and meta-analysis.

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    Lanting, Sean M; Johnson, Nathan A; Baker, Michael K; Caterson, Ian D; Chuter, Vivienne H

    2017-02-01

    This study aimed to review the efficacy of exercise training for improving cutaneous microvascular reactivity in response to local stimulus in human adults. Systematic review with meta-analysis. A systematic search of Medline, Cinahl, AMED, Web of Science, Scopus, and Embase was conducted up to June 2015. Included studies were controlled trials assessing the effect of an exercise training intervention on cutaneous microvascular reactivity as instigated by local stimulus such as local heating, iontophoresis and post-occlusive reactive hyperaemia. Studies where the control was only measured at baseline or which included participants with vasospastic disorders were excluded. Two authors independently reviewed and selected relevant controlled trials and extracted data. Quality was assessed using the Downs and Black checklist. Seven trials were included, with six showing a benefit of exercise training but only two reaching statistical significance with effect size ranging from -0.14 to 1.03. The meta-analysis revealed that aerobic exercise had a moderate statistically significant effect on improving cutaneous microvascular reactivity (effect size (ES)=0.43, 95% CI: 0.08-0.78, p=0.015). Individual studies employing an exercise training intervention have tended to have small sample sizes and hence lacked sufficient power to detect clinically meaningful benefits to cutaneous microvascular reactivity. Pooled analysis revealed a clear benefit of exercise training on improving cutaneous microvascular reactivity in older and previously inactive adult cohorts. Exercise training may provide a cost-effective option for improving cutaneous microvascular reactivity in adults and may be of benefit to those with cardiovascular disease and metabolic disorders such as diabetes. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  6. 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.

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

    Science.gov (United States)

    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.

  8. 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.

  9. 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

  10. 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)

  11. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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. 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.

  14. 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.

  15. 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.

  16. 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

  17. 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.

  18. 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.

  19. 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.

  20. Cerebral microvascular blood flow and CO2 reactivity in pulmonary arterial hypertension.

    Science.gov (United States)

    Treptow, Erika; Oliveira, Mayron F; Soares, Aline; Ramos, Roberta P; Medina, Luiz; Lima, Rita; Alencar, Maria Clara; Ferreira, Eloara Vieira; Ota-Arakaki, Jaquelina S; Tufik, Sergio; Nery, Luiz E; Bittencourt, Lia Rita; Neder, J Alberto

    2016-11-01

    Hypocapnia and endothelial dysfunction might impair microvascular cerebral blood flow (CBFmicr) and cerebrovascular reactivity to CO2 (CVRCO2). Pulmonary arterial hypertension (PAH) is characteristically associated with chronic alveolar hyperventilation and microvascular endothelial dysfunction. We therefore determined CBFmicr (pre-frontal blood flow index (BFI) by the indocyanine green-near infrared spectroscopy methodology) during hypocapnia and hypercapnia in 25 PAH patients and 10 gender- and age-matched controls. Cerebral BFI was lower in patients than controls at similar transcutaneous PCO2 (PtcCO2) levels in both testing conditions. In fact, while BFI increased from hypocapnia to hypercapnia in all controls, it failed to increase in 17/25 (68%) patients. Thus, BFI increased to a lesser extent from hypo to hypercapnia ("Δ") in patients, i.e., they showed lower Δ BFI/Δ PtcCO2 ratios than controls. In conclusion, CBFmicr and CVRCO2 are lessened in clinically stable, mildly-impaired patients with PAH. These abnormalities might be associated with relevant clinical outcomes (hyperventilation and dyspnea, cognition, cerebrovascular disease) being potentially amenable to pharmacological treatment. Copyright © 2016 Elsevier B.V. All rights reserved.

  1. 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.

  2. Eccentric exercise slows in vivo microvascular reactivity during brief contractions in human skeletal muscle.

    Science.gov (United States)

    Larsen, Ryan G; Hirata, Rogerio P; Madzak, Adnan; Frøkjær, Jens B; Graven-Nielsen, Thomas

    2015-12-01

    Unaccustomed exercise involving eccentric contractions results in muscle soreness and an overall decline in muscle function, however, little is known about the effects of eccentric exercise on microvascular reactivity in human skeletal muscle. Fourteen healthy men and women performed eccentric contractions of the dorsiflexor muscles in one leg, while the contralateral leg served as a control. At baseline, and 24 and 48 h after eccentric exercise, the following were acquired bilaterally in the tibialis anterior muscle: 1) transverse relaxation time (T2)-weighted magnetic resonance images to determine muscle cross-sectional area (mCSA) and T2; 2) blood oxygen level-dependent (BOLD) images during and following brief, maximal voluntary contractions (MVC) to monitor the hyperemic responses with participants positioned supine in a 3T magnet; 3) muscle strength; and 4) pain pressure threshold. Compared with the control leg, eccentric exercise resulted in soreness, decline in strength (∼20%), increased mCSA (∼7%), and prolonged T2 (∼7%) at 24 and 48 h (P eccentric exercise, such that time-to-peak (∼35%, P eccentric exercise may impede rapid adjustments in muscle blood flow at exercise onset and during activities involving brief bursts of muscle activation, which may impair O2 delivery and contribute to reduced muscle function after eccentric exercise. Copyright © 2015 the American Physiological Society.

  3. 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

  4. 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

  5. Effects of acrylic resin monomers on porcine coronary artery reactivity.

    Science.gov (United States)

    Abebe, Worku; West, Daniel; Rueggeberg, Frederick A; Pashley, David; Mozaffari, Mahmood S

    2016-07-01

    The purpose of the present investigation was to assess the reactivity of porcine coronary arteries under in vitro conditions following their exposure to methyl methacrylate (MMA) and hydroxyethyl methacrylate (HEMA) monomers. Confirming previous studies using rat aortas, both MMA and HEMA induced acute/direct relaxation of coronary ring preparations, which was partly dependent on the endothelium. With prolonged tissue exposure, both monomers caused time- and concentration-dependent inhibition of receptor-mediated contraction of the vascular smooth muscle caused by prostaglandin F2∝ (PGF2∝), with HEMA causing more inhibition than MMA. Hydroxyethyl methacrylate, but not MMA, also produced impairment of non-receptor-mediated contraction of the coronary smooth muscle induced by KCl. On the other hand, neither HEMA nor MMA altered relaxation of the smooth muscle produced by the direct-acting pharmacological agent, sodium nitroprusside (SNP). While exposure to HEMA impaired endothelium-dependent vasorelaxation caused by bradykinin (BK), MMA markedly enhanced this endothelial-mediated response of the arteries. The enhanced endothelial response produced by MMA was linked to nitric oxide (NO) release. In conclusion, with prolonged tissue exposure, MMA causes less pronounced effects/adverse consequences on coronary smooth muscle function relative to the effect of HEMA, while enhancing vasorelaxation associated with release of NO from the endothelium. Accordingly, MMA-containing resin materials appear to be safer for human applications than materials containing HEMA.

  6. 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.

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

    DEFF Research Database (Denmark)

    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...

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  9. Comparison of skin microvascular reactivity with hemostatic markers of endothelial dysfunction and damage in type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Sandra Beer

    2008-12-01

    Full Text Available Sandra Beer1,2, François Feihl1, Juan Ruiz2, Irène Juhan-Vague3, Marie-Françoise Aillaud3, Sandrine Golay Wetzel1, Lucas Liaudet4, Rolf C Gaillard2, Bernard Waeber1Centre Hospitalier Universitaire Vaudois, Division de Physiopathologie Clinique, Lausanne, Suisse1Division de Physiopathologie Clinique, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Suisse; 2Service d’Endocrinologie, de Diabétologie et de Métabolisme, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Suisse; 3Laboratoire d’hématologie, Centre Hospitalier Universitaire de Marseille; Inserm UMR 626, Marseille, France; 4Service de Médecine Intensive de l’Adulte, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, SuisseAim: Patients with non-insulin-dependent diabetes mellitus (NIDDM are at increased cardiovascular risk due to an accelerated atherosclerotic process. The present study aimed to compare skin microvascular function, pulse wave velocity (PWV, and a variety of hemostatic markers of endothelium injury [von Willebrand factor (vWF, plasminogen activator inhibitor-1 (PAI-1, tissue plasminogen activator (t-PA, tissue factor pathway inhibitor (TFPI, and the soluble form of thrombomodulin (s-TM] patients with NIDDM.Methods: 54 patients with NIDDM and 38 sex- and age-matched controls were studied. 27 diabetics had no overt micro- and/or macrovascular complications, while the remainder had either or both. The forearm skin blood flow was assessed by laser-Doppler imaging, which allowed the measurement of the response to iontophoretically applied acetylcholine (endotheliumdependent vasodilation and sodium nitroprusside (endothelium-independent vasodilation, as well as the reactive hyperemia triggered by the transient occlusion of the circulation.Results: Both endothelial and non-endothelial reactivity were significantly blunted in diabetics, regardless of the presence or the absence of

  10. 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.).

  11. Are C-Reactive Protein Associated Genetic Variants Associated with Serum Levels and Retinal Markers of Microvascular Pathology in Asian Populations from Singapore?

    NARCIS (Netherlands)

    R. Dorajoo (Rajkumar); R. Li (Rui); M.K. Ikram (Kamran); J. Liu (Jinhua); P. Froguel (Philippe); J.J. Lee (Jessica); X. Sim (Xueling); R.T.H. Ong (Rick Twee-Hee); W.-T. Tay; C. Peng (Cheng); T.L. Young (Terri); A.I.F. Blakemore (Alexandra); C.-Y. Cheng; T. Aung (Tin); P. Mitchell (Paul); J.J. Wang (Jie Jin); C.C.W. Klaver (Caroline); E.A. Boerwinkle (Eric); R.J. Klein (Robert); D.S. Siscovick (David); R.A. Jensen (Richard); V. Gudnason (Vilmundur); A.V. Smith (Albert Vernon); Y.Y. Teo (Yik Ying); T.Y. Wong (Tien); E.S. Tai (Shyong); C.K. Heng (Chew-Kiat); Y. Friedlander (Yechiel)

    2013-01-01

    textabstractIntroduction:C-reactive protein (CRP) levels are associated with cardiovascular disease and systemic inflammation. We assessed whether CRP-associated loci were associated with serum CRP and retinal markers of microvascular disease, in Asian populations.Methods:Genome-wide association ana

  12. C-reactive protein, inflammation and coronary heart disease

    Directory of Open Access Journals (Sweden)

    Amit Kumar Shrivastava

    2015-06-01

    Full Text Available Inflammation is widely considered to be an important contributing factor of the pathophysiology of coronary heart disease (CHD, and the inflammatory cascade is particularly important in the atherosclerotic process. In consideration of the important role that inflammatory processes play in CHD, recent work has been focused on whether biomarkers of inflammation may help to improve risk stratification and identify patient groups who might benefit from particular treatment strategies. Of these biomarkers, C-reactive protein (CRP has emerged as one of the most important novel inflammatory markers. CRP an acute phase protein is synthesized by hepatocytes in response to proinflammatory cytokines, in particular interleukin-6. Many large-scale prospective studies demonstrate that CRP strongly and independently predicts adverse cardiovascular events, including myocardial infarction, ischemic stroke, and sudden cardiac death in individuals both with and without overt CHD. CRP is believed to be both a marker and a mediator of atherosclerosis and CHD. CRP plays a pivotal role in many aspects of atherogenesis including, activation of complement pathway, lipids uptake by macrophage, release of proinflammatory cytokines, induces the expression of tissue factor in monocytes, promotes the endothelial dysfunction and inhibits nitric oxide production. The commercial availability of CRP high sensitive assays has made screening for this marker simple, reliable, and reproducible and can be used as a clinical guide to diagnosis, management, and prognosis of CHD.

  13. Iron oxide nanoparticles induce human microvascular endothelial cell permeability through reactive oxygen species production and microtubule remodeling

    Directory of Open Access Journals (Sweden)

    Shi Xianglin

    2009-01-01

    Full Text Available Abstract Background Engineered iron nanoparticles are being explored for the development of biomedical applications and many other industry purposes. However, to date little is known concerning the precise mechanisms of translocation of iron nanoparticles into targeted tissues and organs from blood circulation, as well as the underlying implications of potential harmful health effects in human. Results The confocal microscopy imaging analysis demonstrates that exposure to engineered iron nanoparticles induces an increase in cell permeability in human microvascular endothelial cells. Our studies further reveal iron nanoparticles enhance the permeability through the production of reactive oxygen species (ROS and the stabilization of microtubules. We also showed Akt/GSK-3β signaling pathways are involved in iron nanoparticle-induced cell permeability. The inhibition of ROS demonstrate ROS play a major role in regulating Akt/GSK-3β – mediated cell permeability upon iron nanoparticle exposure. These results provide new insights into the bioreactivity of engineered iron nanoparticles which can inform potential applications in medical imaging or drug delivery. Conclusion Our results indicate that exposure to iron nanoparticles induces an increase in endothelial cell permeability through ROS oxidative stress-modulated microtubule remodeling. The findings from this study provide new understandings on the effects of nanoparticles on vascular transport of macromolecules and drugs.

  14. Pentosan polysulfate preserves renal microvascular P2X1 receptor reactivity and autoregulatory behavior in DOCA-salt hypertensive rats.

    Science.gov (United States)

    Guan, Zhengrong; Singletary, Sean T; Cha, Haword; Van Beusecum, Justin P; Cook, Anthony K; Pollock, Jennifer S; Pollock, David M; Inscho, Edward W

    2016-03-15

    microvascular reactivity to P2X1 receptor activation.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  16. 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.

  17. Association between C reactive protein and coronary heart disease: mendelian randomisation analysis based on individual participant data

    DEFF Research Database (Denmark)

    Wensley, Frances; Gao, Pei; Burgess, Stephen

    2011-01-01

    To use genetic variants as unconfounded proxies of C reactive protein concentration to study its causal role in coronary heart disease.......To use genetic variants as unconfounded proxies of C reactive protein concentration to study its causal role in coronary heart disease....

  18. 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.

  19. 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.

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

    Science.gov (United States)

    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.

  1. Study of Plasma Malondialdehyde, Troponin I and C - Reactive protein in Acute Coronary Syndromes Patients

    Directory of Open Access Journals (Sweden)

    S. Shams

    2006-04-01

    Full Text Available Introduction & Objective: Ischemic injury of endothelium is associated with prostaglandin synthesis and platelet adhesion and aggregation, which may be associated with the release of aldehydes such as malondialdehyde (MDA. C-reactive protein and cardiac troponin I have been proposed as diagnostic markers of acute coronary syndromes. In this study, we compared the usefulness of plasma MDA as a marker of acute coronary syndromes with that of C-reactive protein and troponin I.Material & Methods: The study population contained 50 patients with unstable angina and 50 patients with acute myocardial infarction admitted to the hearth department of the Ekbatan Hospital of Hamadan. The subjects were matched according to age and sex. Total cholesterol, LDL and HDL cholesterol, triglycerides, plasma MDA, troponin I and C-reactive protein levels were determined in all patients. Results: Results showed that the plasma MDA levels were significantly higher in patients with acute myocardial infarction than in individuals with unstable angina (P<0.001 and were associated with increased levels of troponin I and C-reactive protein (P<0.001.Conclusion: The combination of the plasma MDA levels, which reflect endothelial injury, and troponin I and C-reactive protein levels may allow better discrimination in acute coronary syndromes patients.

  2. Persistent Reactive Thrombocytosis May Increase the Risk of Coronary Artery Disease Among Inflammatory Bowel Disease Patients.

    Science.gov (United States)

    Thapa, Sudeep Dhoj; Hadid, Hiba; Imam, Waseem; Hassan, Ahmad; Usman, Muhammad; Jafri, Syed-Mohammed; Schairer, Jason

    2015-10-01

    IBD patients are at increased risk of coronary artery disease in the absence of traditional risk factors. However, the disease-related risk factors remain poorly understood although increased inflammation seems to increase cardiovascular disease risk in IBD. Thrombocytes are involved in the pathogenesis of coronary artery disease, and a subset of IBD patients have reactive thrombocytosis. The aim of our study was to investigate the effect of persistent reactive thrombocytosis on the development of coronary artery disease in IBD. We evaluated a retrospective cohort of 2525 IBD patients who were evaluated at the Henry Ford hospital from 2000 to 2004. We performed a case-control study comparing patients with persistent thrombocytosis and patients without persistent thrombocytosis. Cases (n = 36) and controls (n = 72) were matched for age and gender. Coronary artery disease incidence was compared between the two groups. Cases (n = 36) and controls (n = 72) were matched for age and gender. Cases and controls were similar in age at onset of IBD (41.5 vs. 35.5, p value 0.11) and smoking status (33.3 vs. 27.8%, p value 0.66). Persistent thrombocytosis was less common among Caucasian patients (44.44 vs. 62.5%, p value 0.09) and more common in patients who had exposure to steroids during the study follow-up period. Coronary artery disease occurred in 13 (36.1%) patients with persistent thrombocytosis compared to only seven (9.7%) patients in the control group. Persistent reactive thrombocytosis among IBD patients is associated with increased risk of coronary artery disease. Further studies should characterize the clinical and molecular associations of this phenomenon and determine appropriate therapeutic measures.

  3. Clopidogrel discontinuation and platelet reactivity following coronary stenting

    LENUS (Irish Health Repository)

    2011-01-01

    Summary. Aims: Antiplatelet therapy with aspirin and clopidogrel is recommended for 1 year after drug-eluting stent (DES) implantation or myocardial infarction. However, the discontinuation of antiplatelet therapy has become an important issue as recent studies have suggested a clustering of ischemic events within 90 days of clopidogrel withdrawal. The objective of this investigation was to explore the hypothesis that there is a transient ‘rebound’ increase in platelet reactivity within 3 months of clopidogrel discontinuation. Methods and Results: In this prospective study, platelet function was assessed in patients taking aspirin and clopidogrel for at least 1 year following DES implantation. Platelet aggregation was measured using a modification of light transmission aggregometry in response to multiple concentrations of adenosine diphosphate (ADP), epinephrine, arachidonic acid, thrombin receptor activating peptide and collagen. Clopidogrel was stopped and platelet function was reassessed 1 week, 1 month and 3 months later. Thirty-two patients on dual antiplatelet therapy were recruited. Discontinuation of clopidogrel increased platelet aggregation to all agonists, except arachidonic acid. Platelet aggregation in response to ADP (2.5, 5, 10, and 20 μm) and epinephrine (5 and 20 μm) was significantly increased at 1 month compared with 3 months following clopidogrel withdrawal. Thus, a transient period of increased platelet reactivity to both ADP and epinephrine was observed 1 month after clopidogrel discontinuation. Conclusions: This study demonstrates a transient increase in platelet reactivity 1 month after clopidogrel withdrawal. This phenomenon may, in part, explain the known clustering of thrombotic events observed after clopidogrel discontinuation. This observation requires confirmation in larger populations.

  4. C-reactive protein and angiographic characteristics of stable and unstable coronary artery disease : Data from the prospective PREVEND cohort

    NARCIS (Netherlands)

    Geluk, C.A.; Post, W.J.; Hillege, H.L.; Tio, R.A.; Tijssen, J.G.; van Dijk, R.B.; Dijk, Willem; Bakker, S.J.; de Jong, P.E.; van Gilst, W.H.; Zijlstra, F.

    2008-01-01

    Aims: High sensitive-C-reactive protein (hs-CRP) is associated with coronary risk, which may be explained by an association with (unstable) coronary artery disease (CAD). Until now, histopathological and angiographic studies have failed to consistently demonstrate a strong relationship. However, mos

  5. Gamma glutamyltransferase levels and its association with high sensitive C-reactive protein in patients with acute coronary syndromes

    Science.gov (United States)

    Emiroglu, Mehmet Yunus; Esen, Özlem Batukan; Bulut, Mustafa; Karapinar, Hekim; Kaya, Zekeriya; Akcakoyun, Mustafa; Kargin, Ramazan; Aung, Soe Moe; Alızade, Elnur; Pala, Selcuk; Esen, Ali Metin

    2010-01-01

    Background: Elevated Gamma-glutamyltransferase (GGT) level is independently correlated with conditions associatedwith increased atherosclerosis, such as obesity, elevated serum cholesterol, high blood pressure and myocardial infarction. It is also demonstrated that serum gamma-glutamyltransferase activity is an independent risk factor for myocardial infarction and cardiac death in patients with coronary artery disease. Although the relationship between gamma-glutamyltransferase and coronary artery disease has been reported, not many studies have shown the relationship between changes ofgamma-glutamyltransferase in acute coronary syndromes and a well established coronary risk factor high sensitive C-reactive protein. (hs-CRP). Aims: In this study, how gamma-glutamyltransferase levels changed in acute coronary syndromes and its relationship with high sensitive C-reactive protein if any were studied. Patients & Methods: This trial was carried out at Kosuyolu Cardiovascular Training and Research Hospital and Van Yuksek Ihtisas Hospital, Turkey. 219 patients (177 males and 42 females) presenting with acute coronary syndrome, and 51 control subjects between September 2007 and September 2008 were included in the study. Serum gamma-glutamyltransferase, high sensitive C-reactive protein, serum lipoprotein levels and troponin I were determined. Results: Serum gamma-glutamyltransferase and high sensitive C-reactive protein levels were higher in acute coronary syndrome patients compared to control. There was also correlation between gamma-glutamyltransferase and high sensitive C-reactive protein levels. Conclusion: Serum gamma-glutamyltransferase and high sensitive C-reactive protein levels were higher in acute coronary syndrome patients. In subgroup analyses, the higher difference with Non-ST elevation myocardial infarction and ST elevation myocardial infarction groups than unstable angina oectoris group proposes a relationship between gamma-glutamyltransferase and severity

  6. Gamma glutamyltransferase levels and its association with high sensitive C-reactive protein in patients with acute coronary syndromes

    Directory of Open Access Journals (Sweden)

    Mehmet Yunus Emiroglu

    2010-07-01

    Full Text Available Background: Elevated Gamma-glutamyltransferase (GGT level is independently correlated with conditions associatedwith increased atherosclerosis, such as obesity, elevated serum cholesterol, high blood pressure and myocardial infarction. It is also demonstrated that serum gamma-glutamyltransferase activity is an independent risk factor for myocardial infarction and cardiac death in patients with coronary artery disease. Although the relationship between gamma-glutamyltransferase and coronary artery disease has been reported, not many studies have shown the relationship between changes ofgamma-glutamyltransferase in acute coronary syndromes and a well established coronary risk factor high sensitive C-reactive protein. (hs-CRP. Aims: In this study, how gamma-glutamyltransferase levels changed in acute coronary syndromes and its relationship with high sensitive C-reactive protein if any were studied. Patients & Methods:This trial was carried out at Kosuyolu Cardiovascular Training and Research Hospital and Van Yuksek Ihtisas Hospital, Turkey. 219 patients (177 males and 42 females presenting with acute coronary syndrome, and 51 control subjects between September 2007 and September 2008 were included in the study. Serum gamma-glutamyltransferase, high sensitive C-reactive protein, serum lipoprotein levels and troponin I were determined. Results: Serum gamma-glutamyltransferase and high sensitive C-reactive protein levels were higher in acute coronary syndrome patients compared to control. There was also correlation between gamma-glutamyltransferase and high sensitive C-reactive protein levels. Conclusion: Serum gamma-glutamyltransferase and high sensitive C-reactive protein levels were higher in acute coronary syndrome patients. In subgroup analyses, the higher difference with Non-ST elevation myocardial infarction and ST elevation myocardial infarction groups than unstable angina oectoris group proposes a relationship between gamma

  7. Gamma glutamyltransferase levels and its association with high sensitive C-reactive protein in patients with acute coronary syndromes

    Directory of Open Access Journals (Sweden)

    Mehmet Yunus Emiroglu

    2010-01-01

    Full Text Available Background: Elevated Gamma-glutamyltransferase (GGT level is independently correlated with conditions associatedwith increased atherosclerosis, such as obesity, elevated serum cholesterol, high blood pressure and myocardial infarction. It is also demonstrated that serum gamma-glutamyltransferase activity is an independent risk factor for myocardial infarction and cardiac death in patients with coronary artery disease. Although the relationship between gamma-glutamyltransferase and coronary artery disease has been reported, not many studies have shown the relationship between changes ofgamma-glutamyltransferase in acute coronary syndromes and a well established coronary risk factor high sensitive C-reactive protein. (hs-CRP. Aims: In this study, how gamma-glutamyltransferase levels changed in acute coronary syndromes and its relationship with high sensitive C-reactive protein if any were studied. Patients & Methods: This trial was carried out at Kosuyolu Cardiovascular Training and Research Hospital and Van Yuksek Ihtisas Hospital, Turkey. 219 patients (177 males and 42 females presenting with acute coronary syndrome, and 51 control subjects between September 2007 and September 2008 were included in the study. Serum gamma-glutamyltransferase, high sensitive C-reactive protein, serum lipoprotein levels and troponin I were determined. Results: Serum gamma-glutamyltransferase and high sensitive C-reactive protein levels were higher in acute coronary syndrome patients compared to control. There was also correlation between gamma-glutamyltransferase and high sensitive C-reactive protein levels. Conclusion: Serum gamma-glutamyltransferase and high sensitive C-reactive protein levels were higher in acute coronary syndrome patients. In subgroup analyses, the higher difference with Non-ST elevation myocardial infarction and ST elevation myocardial infarction groups than unstable angina oectoris group proposes a relationship between gamma

  8. Testosterone Replacement Therapy Prevents Alterations of Coronary Vascular Reactivity Caused by Hormone Deficiency Induced by Castration.

    Science.gov (United States)

    Rouver, Wender Nascimento; Delgado, Nathalie Tristão Banhos; Menezes, Jussara Bezerra; Santos, Roger Lyrio; Moyses, Margareth Ribeiro

    2015-01-01

    The present study aimed to determine the effects of chronic treatment with different doses of testosterone on endothelium-dependent coronary vascular reactivity in male rats. Adult male rats were divided into four experimental groups: control (SHAM), castrated (CAST), castrated and immediately treated subcutaneously with a physiological dose (0.5 mg/kg/day, PHYSIO group) or supraphysiological dose (2.5 mg/kg/day, SUPRA group) of testosterone for 15 days. Systolic blood pressure (SBP) was assessed at the end of treatment through tail plethysmography. After euthanasia, the heart was removed and coronary vascular reactivity was assessed using the Langendorff retrograde perfusion technique. A dose-response curve for bradykinin (BK) was constructed, followed by inhibition with 100 μM L-NAME, 2.8 μM indomethacin (INDO), L-NAME + INDO, or L-NAME + INDO + 0.75 μM clotrimazole (CLOT). We observed significant endothelium-dependent, BK-induced coronary vasodilation, which was abolished in the castrated group and restored in the PHYSIO and SUPRA groups. Furthermore, castration modulated the lipid and hormonal profiles and decreased body weight, and testosterone therapy restored all of these parameters. Our results revealed an increase in SBP in the SUPRA group. In addition, our data led us to conclude that physiological concentrations of testosterone may play a beneficial role in the cardiovascular system by maintaining an environment that is favourable for the activity of an endothelium-dependent vasodilator without increasing SBP.

  9. Testosterone Replacement Therapy Prevents Alterations of Coronary Vascular Reactivity Caused by Hormone Deficiency Induced by Castration.

    Directory of Open Access Journals (Sweden)

    Wender Nascimento Rouver

    Full Text Available The present study aimed to determine the effects of chronic treatment with different doses of testosterone on endothelium-dependent coronary vascular reactivity in male rats. Adult male rats were divided into four experimental groups: control (SHAM, castrated (CAST, castrated and immediately treated subcutaneously with a physiological dose (0.5 mg/kg/day, PHYSIO group or supraphysiological dose (2.5 mg/kg/day, SUPRA group of testosterone for 15 days. Systolic blood pressure (SBP was assessed at the end of treatment through tail plethysmography. After euthanasia, the heart was removed and coronary vascular reactivity was assessed using the Langendorff retrograde perfusion technique. A dose-response curve for bradykinin (BK was constructed, followed by inhibition with 100 μM L-NAME, 2.8 μM indomethacin (INDO, L-NAME + INDO, or L-NAME + INDO + 0.75 μM clotrimazole (CLOT. We observed significant endothelium-dependent, BK-induced coronary vasodilation, which was abolished in the castrated group and restored in the PHYSIO and SUPRA groups. Furthermore, castration modulated the lipid and hormonal profiles and decreased body weight, and testosterone therapy restored all of these parameters. Our results revealed an increase in SBP in the SUPRA group. In addition, our data led us to conclude that physiological concentrations of testosterone may play a beneficial role in the cardiovascular system by maintaining an environment that is favourable for the activity of an endothelium-dependent vasodilator without increasing SBP.

  10. Effects of polymorphisms of NOS3 and GNB3 genes on skin microvascular reactivity in normal pregnancy.

    Science.gov (United States)

    Radkov, O V; Volf, Ju V

    2013-05-01

    We studied the relationship between endothelial NO-synthase gene (NOS3) and G protein β3 subunit gene (GNB3) polymorphisms and reactivity of skin microvessels during physiological gestation. T-786C NOS3 polymorphism influenced the maximum blood flow rate in skin microvessels and the severity of postocclusive reactive hyperemia during the third trimester of pregnancy. The relationship between G894T NOS3 polymorphism and the duration of postocclusive reactive hyperemia was revealed. C825T GNB3 polymorphism affects the duration and severity of postocclusive reactive hyperemia during the first and third trimesters of pregnancy. Thus, NOS3 and GNB3 polymorphisms affect blood flow in the skin microvessels during physiological gestation.

  11. Highly sensitive C-reactive protein and male gender are independently related to the severity of coronary disease in patients with metabolic syndrome and an acute coronary event

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    C.M.C. Monteiro

    2010-03-01

    Full Text Available Patients with metabolic syndrome are at high-risk for development of atherosclerosis and cardiovascular events. The objective of this study was to examine the major determinants of coronary disease severity, including those coronary risk factors associated with metabolic syndrome, during the early period after an acute coronary episode. We tested the hypothesis that inflammatory markers, especially highly sensitive C-reactive protein (hsCRP, are related to coronary atherosclerosis, in addition to traditional coronary risk factors. Subjects of both genders aged 30 to 75 years (N = 116 were prospectively included if they had suffered a recent acute coronary syndrome (acute myocardial infarction or unstable angina pectoris requiring hospitalization and if they had metabolic syndrome diagnosed according to the National Cholesterol Education Program/Adult Treatment Panel III. Patients were submitted to a coronary angiography and the burden of atherosclerosis was estimated by the Gensini score. The severity of coronary disease was correlated (Spearman’s or Pearson’s coefficient with gender (r = 0.291, P = 0.008, age (r = 0.218, P = 0.048, hsCRP (r = 0.256, P = 0.020, ApoB/ApoA ratio (r = 0.233, P = 0.041, and carotid intima-media thickness (r = 0.236, P = 0.041. After multiple linear regression, only male gender (P = 0.046 and hsCRP (P = 0.012 remained independently associated with the Gensini score. In this high-risk population, male gender and high levels of hsCRP, two variables that can be easily obtained, were associated with more extensive coronary disease, identifying patients with the highest potential of developing new coronary events.

  12. Association of C-reactive protein and homocysteine with subclinical coronary plaque subtype and stenosis using low-dose MDCT coronary angiography.

    Science.gov (United States)

    Lin, Tsann; Liu, Juhn-Cherng; Chang, Li-Ya; Shen, Chien-Wei

    2010-10-01

    Given the uncertainty regarding the relationship of C-reactive protein (CRP) and homocysteine (Hcy) to atherosclerotic burden, our aim was to determine whether CRP and Hcy are related to the presence of subclinical coronary plaque and stenosis. We did a cross-sectional analysis of data gathered on 1248 consecutive, newly self-referred, middle-aged subjects who underwent health check ups at China Medical University Hospital. Participants had at least one cardiac risk factor, but no known coronary heart disease. Low-dose multidetector computed tomography coronary angiography (MDCT-CA) was used to measure coronary artery stenosis and identify plaque subtypes. Subjects were divided into quartiles based on levels of high-sensitivity (hs)-CRP and Hcy. hs-CRP level and Hcy level were associated with the relative proportion of plaque subtypes; Hcy level (P0.05) was associated with prevalence of artery segment stenosis. After multivariate adjustment for traditional cardiovascular risk factors through logistic regression analysis, neither hs-CRP level nor Hcy level was independently associated with coronary plaque subtypes and stenosis (P>0.05). Subclinical atherosclerosis is mildly increased in subjects with higher CRP and Hcy levels, but this association is not independent of traditional cardiovascular risk factors. CRP and Hcy are poor predictors of atherosclerotic burden and coronary stenosis. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  13. Are C-reactive protein associated genetic variants associated with serum levels and retinal markers of microvascular pathology in Asian populations from Singapore?

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    Rajkumar Dorajoo

    Full Text Available INTRODUCTION: C-reactive protein (CRP levels are associated with cardiovascular disease and systemic inflammation. We assessed whether CRP-associated loci were associated with serum CRP and retinal markers of microvascular disease, in Asian populations. METHODS: Genome-wide association analysis (GWAS for serum CRP was performed in East-Asian Chinese (N = 2,434 and Malays (N = 2,542 and South-Asian Indians (N = 2,538 from Singapore. Leveraging on GWAS data, we assessed, in silico, association levels among the Singaporean datasets for 22 recently identified CRP-associated loci. At loci where directional inconsistencies were observed, quantification of inter-ethnic linkage disequilibrium (LD difference was determined. Next, we assessed association for a variant at CRP and retinal vessel traits [central retinal artery equivalent (CRAE and central retinal vein equivalent (CRVE] in a total of 24,132 subjects of East-Asian, South-Asian and European ancestry. RESULTS: Serum CRP was associated with SNPs in/near APOE, CRP, HNF1A and LEPR (p-values ≤4.7×10(-8 after meta-analysis of Singaporean populations. Using a candidate-SNP approach, we further replicated SNPs at 4 additional loci that had been recently identified to be associated with serum CRP (IL6R, GCKR, IL6 and IL1F10 (p-values ≤0.009, in the Singaporean datasets. SNPs from these 8 loci explained 4.05% of variance in serum CRP. Two SNPs (rs2847281 and rs6901250 were detected to be significant (p-value ≤0.036 but with opposite effect directions in the Singaporean populations as compared to original European studies. At these loci we did not detect significant inter-population LD differences. We further did not observe a significant association between CRP variant and CRVE or CRAE levels after meta-analysis of all Singaporean and European datasets (p-value >0.058. CONCLUSIONS: Common variants associated with serum CRP, first detected in primarily European studies, are also

  14. 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 ...

  15. Association between C reactive protein and coronary heart disease : mendelian randomisation analysis based on individual participant data

    NARCIS (Netherlands)

    Wensley, Frances; Gao, Pei; Burgess, Stephen; Kaptoge, Stephen; Di Angelantonio, Emanuele; Shah, Tina; Engert, James C.; Clarke, Robert; Davey-Smith, George; Nordestgaard, Borge G.; Saleheen, Danish; Samani, Nilesh J.; Sandhu, Manjinder; Anand, Sonia; Pepys, Mark B.; Smeeth, Liam; Whittaker, John; Casas, Juan Pablo; Thompson, Simon G.; Hingorani, Aroon D.; Danesh, John; Eiriksdottir, G.; Harris, T. B.; Launer, L. J.; Gudnason, V.; Folsom, A. R.; Andrews, G.; Ballantyne, C. M.; Samani, N. J.; Hall, A. S.; Braund, P. S.; Balmforth, A. J.; Whincup, P. H.; Morris, R.; Lawlor, D. A.; Lowe, G. D. O.; Timpson, N.; Ebrahim, S.; Ben-Shlomo, Y.; Davey-Smith, G.; Timpson, N.; Nordestgaard, B. G.; Tybjaerg-Hansen, A.; Zacho, J.; Brown, M.; Sandhu, M.; Ricketts, S. L.; Ashford, S.; Lange, L.; Reiner, A.; Cushman, M.; Tracy, R.; Wu, C.; Ge, J.; Zou, Y.; Sun, A.; Hung, J.; McQuillan, B.; Thompson, P.; Beilby, J.; Warrington, N.; Palmer, L. J.; Wanner, C.; Drechsler, C.; Hoffmann, M. M.; Fowkes, F. G. R.; Lowe, G. D. O.; Tzoulaki, I.; Kumari, M.; Miller, M.; Marmot, M.; Onland-Moret, C.; van der Schouw, Y. T.; Boer, J. M.; Wijmenga, C.; Ricketts, S. L.; Ashford, S.; Sandhu, M.; Khaw, K-T; Vasan, R. S.; Schnabel, R. B.; Yamamoto, J. F.; Benjamin, E. J.; Schunkert, H.; Erdmann, J.; Koenig, I. R.; Hengstenberg, C.; Chiodini, B.; Franzosi, M. G.; Pietri, S.; Gori, F.; Rudock, M.; Liu, Y.; Lohman, K.; Harris, T. B.; Humphries, S. E.; Hamsten, A.; Norman, P. E.; Hankey, G. J.; Jamrozik, K.; Palmer, L. J.; Rimm, E. B.; Pai, J. K.; Psaty, B. M.; Heckbert, S. R.; Bis, J. C.; Yusuf, S.; Anand, S.; Engert, J. C.; Xie, C.; Collins, R.; Clarke, R.; Bennett, D.; Kooner, J.; Chambers, J.; Elliott, P.; Maerz, W.; Kleber, M. E.; Boehm, B. O.; Winkelmann, B. R.; Melander, O.; Berglund, G.; Koenig, W.; Thorand, B.; Baumert, J.; Peters, A.; Rimm, E. B.; Manson, J.; Pai, J. K.; Humphries, S. E.; Cooper, J. A.; Talmud, P. J.; Ladenvall, P.; Johansson, L.; Jansson, J-H; Hallmans, G.; Reilly, M. P.; Qu, L.; Li, M.; Rader, D. J.; Watkins, H.; Clarke, R.; Hopewell, J.; Saleheen, D.; Danesh, J.; Frossard, P.; Sattar, N.; Robertson, M.; Shepherd, J.; Schaefer, E.; Hofman, A.; Witteman, J. C. M.; Kardys, I.; Dehghan, A.; de Faire, U.; Bennet, A.; Gigante, B.; Leander, K.; Ben-Shlomo, Y.; Davey-Smith, G.; Timpson, N.; Peters, B.; Maitland-van der Zee, A. H.; de Boer, A.; Klungel, O.; Reiner, A.; Manson, J.; Greenland, P.; Dai, J.; Liu, S.; Brunner, E.; Kivimaki, M.; Marmot, M.; Sattar, N.; O'Reilly, D.; Ford, I.; Packard, C. J.

    2011-01-01

    Objective To use genetic variants as unconfounded proxies of C reactive protein concentration to study its causal role in coronary heart disease. Design Mendelian randomisation meta-analysis of individual participant data from 47 epidemiological studies in 15 countries. Participants 194 418

  16. C-reactive protein as a risk factor for acute coronary syndrome

    Institute of Scientific and Technical Information of China (English)

    杨胜利; 何秉贤; 何作云; 张华; 何学兰; 张伟

    2002-01-01

    Objective We assessed thelevels of C-reactive protein ( CRP ) in patients with acute coronary syndrome (ACS) [including unstable angina pectoris (UAP), acute myocardial infarction (AMI) and sudden cardiac death (SCD) ] compared with non-ACS [including stable angina pectoris (SAP), old myocardial infarction (OMI) and healthy volunteers] and sought to test whether CRP are associated with clinical acute coronary syndrome. Methods Ultrasensitive immunoassay (rate nephelometry with the Beckman Array multitest immunoassay system) wasused to measure CRP levels in 91 patients with ACS(20 UAP, 71 AMI including 2 SCD) and non-ACS (34SAP, 25 patients with healing phase of AMI, 41 OMI and 94 control healthy subjects) Results CRP levels were higher in ACS group (18.50 + 23.98 mg/L [ SE 2.51, n = 91 ] ) compared with non - ACS group (3.89+7.14mg/L[SE0.51, n=194]) (P <0.01).Using Logistic Regression, CRP was a potent determinant of ACS ( OR = 1.65) Conclusion These results suggest that CRP has a strong association with ACS, and CRP is a risk factor of ACS.

  17. C-Reactive Protein and Coronary Heart Disease: All Said—Is Not It?

    Directory of Open Access Journals (Sweden)

    Frederik Strang

    2014-01-01

    Full Text Available C-reactive protein (CRP and coronary heart disease (CHD have been the subject of intensive investigations over the last decades. Epidemiological studies have shown an association between moderately elevated CRP levels and incident CHD whereas genetic studies have shown that polymorphisms associated with elevated CRP levels do not increase the risk of ischemic vascular disease, suggesting that CRP might be a bystander rather than a causal factor in the progress of atherosclerosis. Beside all those epidemiological and genetic studies, the experimental investigations also try to reveal the role of CRP in the progress of atherosclerosis. This review will highlight the complex results of genomic, epidemiological, and experimental studies on CRP and will show why further studies investigating the relationship between CRP and atherosclerosis might be needed.

  18. Relationship between high-sensitivity C-reactive protein level and angiographical characteristics of coronary atherosclerosis

    Institute of Scientific and Technical Information of China (English)

    JIA En-zhi; HUANG Jun; MA Wen-zhu; YANG Zhi-jian; YUAN Biao; ZANG Xiao-ling; WANG Rong-hu; ZHU Tie-bing; WANG Lian-sheng; CHEN Bo; CAO Ke-jiang

    2006-01-01

    @@ Arole for inflammation has become well established over the past decade or more in theories describing the atherosclerotic disease process.1,2 From a pathological viewpoint, all stages, ie, initiation, growth, and complication of the atherosclerotic plaque,3,4 might be considered to be an inflammatory response to injury. Several prospective studies 5-7 recently showed that plasma high sensitivity C-reactive protein (hsCRP) levels, which are one of the markers of systemic inflammation, are a powerful predictor of future myocardial infarction and cardiac death among apparently healthy individuals. However, the association between the plasma hsCRP levels and the extent of coronary stenosis in subjects remains controversial. Some studies previously demon- strated such associations,8,9 whereas other could not found.10,11 Gensini's score assigns a severity score for a stenosed vessel depending on the degree of luminal narrowing and the importance of its location.12

  19. The relationship between fractional flow reserve, platelet reactivity and platelet leukocyte complexes in stable coronary artery disease.

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    Jan-Willem E M Sels

    Full Text Available BACKGROUND: The presence of stenoses that significantly impair blood flow and cause myocardial ischemia negatively affects prognosis of patients with stable coronary artery disease. Altered platelet reactivity has been associated with impaired prognosis of stable coronary artery disease. Platelets are activated and form complexes with leukocytes in response to microshear gradients caused by friction forces on the arterial wall or flow separation. We hypothesized that the presence of significantly flow-limiting stenoses is associated with altered platelet reactivity and formation of platelet-leukocyte complexes. METHODS: One hundred patients with stable angina were studied. Hemodynamic significance of all coronary stenoses was assessed with Fractional Flow Reserve (FFR. Patients were classified FFR-positive (at least one lesion with FFR≤0.75 or FFR-negative (all lesions FFR>0.80. Whole blood samples were stimulated with increasing concentrations of ADP, TRAP, CRP and Iloprost with substimulatory ADP. Expression of P-selectin as platelet activation marker and platelet-leukocyte complexes were measured by flowcytometry. Patients were stratified on clopidogrel use. FFR positive and negative patient groups were compared on platelet reactivity and platelet-leukocyte complexes. RESULTS: Platelet reactivity between FFR-positive patients and FFR-negative patients did not differ. A significantly lower percentage of circulating platelet-neutrophil complexes in FFR-positive patients and a similar non-significant decrease in percentage of circulating platelet-monocyte complexes in FFR-positive patients was observed. CONCLUSION: The presence of hemodynamically significant coronary stenoses does not alter platelet reactivity but is associated with reduced platelet-neutrophil complexes in peripheral blood of patients with stable coronary artery disease.

  20. C-reactive protein as a predictor of adverse outcome in patients with acute coronary syndrome

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    A S Sheikh

    2012-01-01

    Full Text Available Background and Objectives: The acute-phase reactant C-reactive protein (CRP has been shown to reflect systemic and vascular inflammation and to predict future cardiovascular events. The objective of this study was to evaluate the prognostic value of CRP in predicting cardiovascular outcome in patients presenting with acute coronary syndromes. Patients and Methods: This prospective, single-centered study was carried out by the Department of Pathology in collaboration with the Department of Cardiology, Bolan Medical College Complex Quetta, Balochistan, Pakistan from January 2009 to December 2009. We studied 963 consecutive patients presenting with chest pain to Accident and Emergency Department. Patients were divided into four groups. Group-1 comprised patients with unstable angina; group-2 included patients with acute ST elevation myocardial infarction (STEMI; group-3 comprised patients with Non-ST elevation myocardial infarction (Non-STEMI and group-4 was the control group. All four groups were followed-up for 90 days for occurrence of cardiovascular events. Results: The CRP was elevated (>3 mg/L among 27.6% patients in Group-1; 70.9% in group- 2; 77.9% in group-3 and 5.3% in the control group. Among cases with elevated CRP, 92.1% had a cardiac event compared to 34.3% among patients with CRP £3 mg/L (P < 0.0001. The mortality was significantly higher (P < 0.0001 in group-2 (8.9% and group-3 (11.9% as compared to group-1 (2.1%. There was no cardiac event or mortality in Group-4. Conclusions: Elevated CRP is a predictor of adverse outcome in patients with acute coronary syndromes and helps in identifying patients who may be at risk of cardiovascular complications.

  1. Coronary Plaque Characteristics Assessed by 256-Slice Coronary CT Angiography and Association with High-Sensitivity C-Reactive Protein in Symptomatic Patients with Type 2 Diabetes

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    Jinling Zhang

    2016-01-01

    Full Text Available Little is known regarding plaque distribution, composition, and the association with inflammation in type 2 diabetes mellitus (DM2. This study aimed to assess the relationship between coronary plaque subtypes and high-sensitivity C-reactive protein levels. Coronary CTA were performed in 98 symptomatic DM2 patients and 107 non-DM2 patients using a 256-slice CT. The extent and types of plaque as well as luminal narrowing were evaluated. Patients with DM2 were more likely to have significant stenosis (>50% with calcified plaques in at least one coronary segment (p<0.01; the prevalence rates of diffuse calcified plaques in the DM2 and non-DM2 groups were 31.6% and 4.7%, respectively (p<0.01. Plasma hs-CRP levels in DM2 with calcified plaques were higher compared with values obtained for the non-DM2 group (p<0.01. In conclusion, combination of coronary CTA and hs-CRP might improve risk stratification in symptomatic DM2 patients.

  2. 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...

  3. Collaborative pooled analysis of data on C-reactive protein gene variants and coronary disease: judging causality by Mendelian randomisation

    DEFF Research Database (Denmark)

    Danesh, J.; Hingorani, A.; Wensley, F.

    2008-01-01

    Many prospective studies have reported associations between circulating C-reactive protein (CRP) levels and risk of coronary heart disease (CHD), but causality remains uncertain. Studies of CHD are being conducted that involve measurement of common polymorphisms of the CRP gene known to be associ...... of low-grade inflammation to CHD and indicate whether or not CRP itself is involved in long-term pathogenesis Udgivelsesdato: 2008...

  4. High-sensitivity C-reactive protein and exercise-induced changes in subjects suspected of coronary artery disease

    DEFF Research Database (Denmark)

    Mouridsen, Mette Rauhe; Nielsen, Olav Wendelboe; Carlsen, Christian Malchau

    2014-01-01

    BACKGROUND: Inflammation plays a major role in the development of atherosclerosis. We wanted to investigate the effects of exercise on high-sensitivity (hs) C-reactive protein (CRP) in subjects who were suspected of having coronary artery disease (CAD). METHODS: Blood samples were obtained before......, 5 minutes after, and 20 hours after an exercise test in 155 subjects who were suspected of CAD. Coronary anatomy was evaluated by computed tomography coronary angiography and/or coronary angiography. RESULTS: Median baseline hs-CRP was higher in subjects with ≥50% coronary artery lumen diameter...... stenosis (n=41), compared with non-CAD-subjects (n=114), 2.93 mg/L (interquartile range 1.03-5.06 mg/L) and 1.30 mg/L (interquartile range 0.76-2.74 mg/L), respectively, P=0.007. In multivariate analyses testing conventional risk factors, hs-CRP proved borderline significant, odds ratio =2.32, P=0...

  5. Predictors of high on-aspirin platelet reactivity in elderly patients with coronary artery disease.

    Science.gov (United States)

    Zhang, J W; Liu, W W; McCaffrey, Timothy A; He, X Q; Liang, W Y; Chen, X H; Feng, X R; Fu, Sidney W; Liu, M L

    2017-01-01

    Previous studies have illustrated the link between high on-aspirin platelet reactivity (HAPR) with increasing thrombotic risks. The aim of our study was to investigate relative risk factors of HAPR in elderly patients with coronary artery disease. Elderly, hospitalized coronary artery disease patients on regular aspirin treatment were enrolled from January 2014 to September 2016. Medical records of each patient were collected, including demographic information, cardiovascular risk factors, concomitant drugs and routine biological parameters. Arachidonic acid (AA, 0.5 mg/mL) and adenosine diphosphate (ADP, 5 µmol/L) induced platelet aggregation were measured via light transmission assay (LTA) to evaluate antiplatelet responses, referred as LTA-AA and LTA-ADP. A total of 275 elderly patients were included, with mean age of 77.2±8.1 years, and males accounted for 81.8%. HAPR was defined as LTA-AA in the upper quartile of the enrolled population. HAPR patients tended to have lower renal function (P=0.052). Higher serum uric acid (SUA) level, as well as lower platelet count, hemoglobin and hematocrit were observed in HAPR patients, with a higher proportion of diuretics use (P<0.05). Multivariate analysis revealed that SUA (OR: 1.004, 95% CI: 1.000-1.007, P=0.048), platelet count (OR: 0.994, 95% CI: 0.989-1.000, P=0.045), hematocrit (OR: 0.921, 95% CI: 0.864-0.981, P=0.011) and concomitant P2Y12 receptor inhibitors use (OR: 1.965, 95% CI: 1.075-3.592, P=0.028) were correlated with HAPR. Spearman's correlation analysis demonstrated an inverse association of LTA-AA with hematocrit (r=-0.234, P<0.001), hemoglobin (r=-0.209, P<0.001) and estimated glomerular filtration rate (r=-0.132, P=0.031). SUA, platelet count, hematocrit and P2Y12 receptor inhibitors use were independently correlated with HAPR. These parameters might provide novel therapeutic targets for optimizing antiplatelet therapy.

  6. Comparative prognostic value of C-reactive protein & fibrinogen in patients with coronary artery disease

    Directory of Open Access Journals (Sweden)

    Gjin Ndrepepa

    2014-01-01

    Full Text Available Background & objectives: The comparative prognostic value of C-reactive protein (CRP and fibrinogen for cardiovascular events has been inconclusively investigated. t0 his study was carried out to compare the prognostic value of CRP versus fibrinogen in patients with coronary artery disease (CAD. Methods: The study included 13,100 patients with coronary angiography-confirmed CAD. Plasma CRP and fibrinogen levels were measured before angiography in all patients. The levels of CRP>3 mg/l and fibrinogen>350 mg/dl were considered as elevated. The primary outcome was 1-year all-cause mortality. Results: Patients were divided into four groups: patients with CRP≤3 mg/l and fibrinogen ≤350 mg/dl (n=4206; patients with CRP≤3 mg/l and fibrinogen >350 mg/dl (n=3132; patients with CRP>3 mg/l and fibrinogen ≤ 350 mg/dl (n=1273 and CRP >3 mg/l and patients with fibrinogen >350 mg/dl (n=4489. There were 634 deaths: 75 deaths in patients with CRP ≤3 mg/l and fibrinogen ≤350 mg/dl, 91 deaths in patients with CRP ≤3 mg/l and fibrinogen >350 mg/dl, 87 deaths in patients with CRP >3 mg/l and fibrinogen ≤350 mg/dl and 381 deaths in patients with CRP >3 mg/l and fibrinogen >350 mg/dl (Kaplan-Meier estimates of all-cause mortality, 1.8, 3.0, 7.0 and 8.7 %, log-rank test P<0.001. The multivariate analysis showed that CRP [adjusted hazard ratio (HR=1.31, 95% confidence interval (CI 1.18-1.45, for each standard deviation increase in the logarithmic scale] but not fibrinogen [adjusted HR=0.99 (0.90-1.09, for each standard deviation increase in the logarithmic scale] was an independent correlate of mortality. Interpretation & conclusions: The findings indicated that in patients with CAD, CRP was a better predictor of mortality than fibrinogen and offered prognostic information beyond that provided by the conventional cardiovascular risk factors.

  7. 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

  8. 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.

  9. Does C-reactive Protein Add Prognostic Value to GRACE Score in Acute Coronary Syndromes?

    Energy Technology Data Exchange (ETDEWEB)

    Correia, Luis Cláudio Lemos, E-mail: lccorreia@terra.com.br; Vasconcelos, Isis; Garcia, Guilherme; Kalil, Felipe; Ferreira, Felipe; Silva, André; Oliveira, Ruan; Carvalhal, Manuela; Freitas, Caio; Noya-Rabelo, Márcia Maria [Escola Bahiana de Medicina e Saúde Pública, Salvador, BA (Brazil); Hospital São Rafael, Salvador, BA (Brazil)

    2014-05-15

    The incremental prognostic value of plasma levels of C-reactive protein (CRP) in relation to GRACE score has not been established in patients with acute coronary syndrome (ACS) with non-ST segment elevation. To test the hypothesis that CRP measurements at admission increases the prognostic value of GRACE score in patients with ACS. A total of 290 subjects, consecutively admitted for ACS, with plasma material obtained upon admission CRP measurement using a high-sensitivity method (nephelometry) were studied. Cardiovascular outcomes during hospitalization were defined by the combination of death, nonfatal myocardial infarction or nonfatal refractory angina. The incidence of cardiovascular events during hospitalization was 15% (18 deaths, 11 myocardial infarctions, 13 angina episodes) with CRP showing C-statistics of 0.60 (95% CI = 0.51-0.70, p = 0.034) in predicting these outcomes. After adjustment for the GRACE score, elevated CRP (defined as the best cutoff point) tended to be associated with hospital events (OR = 1.89, 95% CI = 0.92 to 3.88, p = 0.08). However, the addition of the variable elevated CRP in the GRACE model did not result in significant increase in C-statistics, which ranged from 0.705 to 0.718 (p = 0.46). Similarly, there was no significant reclassification of risk with the addition of CRP in the predictor model (net reclassification = 5.7 %, p = 0.15). Although CRP is associated with hospital outcomes, this inflammatory marker does not increase the prognostic value of the GRACE score.

  10. Correlation between C-Reactive Protein in Peripheral Vein and Coronary Sinus in Stable and Unstable Angina

    Energy Technology Data Exchange (ETDEWEB)

    Leite, Weverton Ferreira, E-mail: wfleite@cardiol.br [Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP (Brazil); Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP (Brazil); Ramires, José Antonio Franchini; Moreira, Luiz Felipe Pinho; Strunz, Célia Maria Cassaro [Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP (Brazil); Mangione, José Armando [Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP (Brazil)

    2015-03-15

    High sensitivity C-reactive protein (hs-CRP) is commonly used in clinical practice to assess cardiovascular risk. However, a correlation has not yet been established between the absolute levels of peripheral and central hs-CRP. To assess the correlation between serum hs-CRP levels (mg/L) in a peripheral vein in the left forearm (LFPV) with those in the coronary sinus (CS) of patients with coronary artery disease (CAD) and a diagnosis of stable angina (SA) or unstable angina (UA). This observational, descriptive, and cross-sectional study was conducted at the Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, and at the Hospital Beneficência Portuguesa de Sao Paulo, where CAD patients referred to the hospital for coronary angiography were evaluated. Forty patients with CAD (20 with SA and 20 with UA) were included in the study. Blood samples from LFPV and CS were collected before coronary angiography. Furthermore, analysis of the correlation between serum levels of hs-CRP in LFPV versus CS showed a strong linear correlation for both SA (r = 0.993, p < 0.001) and UA (r = 0.976, p < 0.001) and for the entire sample (r = 0.985, p < 0.001). Our data suggest a strong linear correlation between hs-CRP levels in LFPV versus CS in patients with SA and UA.

  11. Correlation between C-Reactive Protein in Peripheral Vein and Coronary Sinus in Stable and Unstable Angina

    Directory of Open Access Journals (Sweden)

    Weverton Ferreira Leite

    2015-03-01

    Full Text Available Background: High sensitivity C-reactive protein (hs-CRP is commonly used in clinical practice to assess cardiovascular risk. However, a correlation has not yet been established between the absolute levels of peripheral and central hs-CRP. Objective: To assess the correlation between serum hs-CRP levels (mg/L in a peripheral vein in the left forearm (LFPV with those in the coronary sinus (CS of patients with coronary artery disease (CAD and a diagnosis of stable angina (SA or unstable angina (UA. Methods: This observational, descriptive, and cross-sectional study was conducted at the Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, and at the Hospital Beneficência Portuguesa de Sao Paulo, where CAD patients referred to the hospital for coronary angiography were evaluated. Results: Forty patients with CAD (20 with SA and 20 with UA were included in the study. Blood samples from LFPV and CS were collected before coronary angiography. Furthermore, analysis of the correlation between serum levels of hs-CRP in LFPV versus CS showed a strong linear correlation for both SA (r = 0.993, p < 0.001 and UA (r = 0.976, p < 0.001 and for the entire sample (r = 0.985, p < 0.001. Conclusion: Our data suggest a strong linear correlation between hs-CRP levels in LFPV versus CS in patients with SA and UA.

  12. C-reactive protein, dietary n-3 fatty acids, and the extent of coronary artery disease

    DEFF Research Database (Denmark)

    Madsen, Trine; Skou, Helle Aarup; Hansen, Vibeke Ellegaard;

    2001-01-01

    was measured using a highly sensitive assay. The results were related to angiographic findings. CRP was significantly higher in patients with significant coronary stenoses than in those with no significant angiographic changes (p

  13. ASSOCIATION OF INSULIN RESISTANCE AND C-REACTIVE PROTEIN WITH CORONARY ARTERY DISEASE IN PATIENTS WITH NORMAL GLUCOSE TOLERANCE

    Institute of Scientific and Technical Information of China (English)

    ZHAO Liang-ping; LV An-kang; SHEN Wei-feng; LIU Hai-feng; ZHANG Qi; DING Feng-hua; ZHANG Rui-yan; CAI Xu; YANG Zhen-kun; HU Jian; ZHANG Jian-sheng

    2009-01-01

    Objective To examine insulin resistance and high sensitivity C-reactive protein (hsCRP) association with clinical and angiographic severity of coronary artery disease (CAD) in patients with normal glucose tolerance.Methods In 638 consecutive patients with normal glucose tolerance, 221 had atypical chest pain and normal coronary artery (control group), 279 had stable angina and CAD (SAP group), and 138 suffered acute myocardial infarction (MI group). The degree of CAD was further divided into borderline lesion (lumen diameter narrowing 50%-69%), significant 1-, 2- or 3-vessel disease (luminal diameter narrowing ≥70%). Fasting serum glucose, insulin and hsCRP levels and lipid profiles were measured, and homeostasis model assessment for insulin resistance (HOMA-IR) was calculated. Multivariate analysis was performed to assess risk factors for 3-vessel disease or acute MI.Results Serum hsCRP, lipoprotein (a) levels, and insulin resistance index (IRI) were higher in AMI group than those in SAP and control groups. Serum hsCRP level and IRI were also higher in 3-vessel disease than those in other groups. Multivariate regression analysis revealed that insulin resistance, cigarette smoking, serum hsCRP, and lipoprotein (a) levels were independent risk factors for acute MI. Lipoprotein (a) elevation was an independent risk factor for 3-vessel disease.Conclusion Insulin resistance and high serum hsCRP level were associated with occurrence of acute MI and angiographic severity of coronary disease in patients with normal glucose tolerance.

  14. 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.

  15. 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.

  16. Differential Short-Term Repeated Forearm Hyperaemic Reactivity in Coronary Artery Disease Patients Compared to Healthy Low Risk Participants

    Directory of Open Access Journals (Sweden)

    Simon L. Bacon

    2012-01-01

    Full Text Available The hyperaemic response of the forearm is a widely used technique to assess the vascular reactivity. Little is known about the short-term reproducibility and the possible exhaustion of this response in normal or diseased states. As such, the current study was conducted to assess this phenomenon using a unique nuclear medicine- (NM- based technique. 19 patients with coronary artery disease (CAD undergoing NM exercise stress tests and 15 low risk (LR participants completed 2 reactive hyperaemia tests, using a SPECT-based technique, separated by 15  min. Analyses revealed that CAD patients had lower hyperaemic responses than LR participants (P<.001, and that there was a significant group × time interaction (P<.005, such that LR participants showed a larger decrease in the reactivity (5.2±0.4 to 3.6±0.4 than the CAD patients (2.9±0.3 to 2.6±0.3. These results suggest that there is a variability, due to disease states, in the reproducibility of the hypaeremic reactivity. This needs to be taken into account in short-term repeated measure studies.

  17. Regional myocardial shortening in relation to graft-reactive hyperemia and flow after coronary bypass surgery

    NARCIS (Netherlands)

    R.W. Brower (Ronald); P.W.J.C. Serruys (Patrick); E. Bos (Egbert); J. Nauta (Jan)

    1979-01-01

    textabstractExtent of regional shortening of myocardium in areas newly perfused by bypass grafting was determined in 56 patients by a new technique employing four to six radiopaque markers sutured in pairs to the epicardium near the coronary anastomosis. Paradoxical systolic expansion (PSE) was mani

  18. Comparison of on-treatment platelet reactivity between triple antiplatelet therapy with cilostazol and standard dual antiplatelet therapy in patients undergoing coronary interventions: a meta-analysis.

    Science.gov (United States)

    Panchal, Hemang B; Shah, Tejaskumar; Patel, Parthavkumar; Albalbissi, Kais; Molnar, Janos; Coffey, Brandon; Khosla, Sandeep; Ramu, Vijay

    2013-11-01

    The recent literature has shown that triple antiplatelet therapy with cilostazol in addition to the standard dual antiplatelet therapy with aspirin and clopidogrel may reduce platelet reactivity and improve clinical outcomes following percutaneous coronary intervention. The purpose of this meta-analysis is to compare the efficacy of triple antiplatelet therapy and dual antiplatelet therapy in regard to on-treatment platelet reactivity. Nine studies (n = 2179) comparing on-treatment platelet reactivity between dual antiplatelet therapy (n = 1193) and triple antiplatelet therapy (n = 986) in patients undergoing percutaneous coronary intervention were included. Primary end points were P2Y12 reaction unit (PRU) and platelet reactivity index (PRI). Secondary end points were platelet aggregation with adenosine diphosphate (ADP) 5 and 20 µmol/L and P2Y12% inhibition. Mean difference (MD) and 95% confidence intervals (CI) were computed and 2-sided α error antiplatelet therapy, triple antiplatelet therapy had significantly lower maximum platelet aggregation with ADP 5 µmol/L (MD: -14.4, CI: -21.6 to -7.2, P antiplatelet therapy significantly lowers platelet reactivity and may explain a decrease in thromboembolic events following coronary intervention; however, additional studies evaluating clinical outcomes will be helpful to determine the benefit of triple antiplatelet therapy.

  19. 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

  20. Platelet reactivity-adjusted antiplatelet therapy in patients with percutaneous coronary intervention: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Xing, Zhenhua; Tang, Liang; Zhu, Zhaowei; Huang, Jiabing; Peng, Xiaofan; Hu, Xinqun

    2017-09-12

    Numerous number of evidences show that high on-treatment platelet reactivity is a well-known risk factor for adverse events in patients after percutaneous coronary intervention (PCI). Controversial situations still exist regarding the effectiveness of tailoring antiplatelet therapy according to platelet function monitoring. The PubMed, Embase, and Cochrane Central databases were searched for randomized trials comparing platelet reactivity-adjusted antiplatelet therapy with conventional antiplatelet therapy in patients undergoing PCI. The primary end point was all-cause mortality, major adverse cardiac events (MACE) including cardiovascular (CV) death, nonfatal myocardial infarction (MI), definite/probable stent thrombosis (ST), revascularization, and stroke or transient ischemic attack (TIA). The safety end point was defined as major bleeding events. We derived pooled risk ratios (RRs) with fixed-effect models. Six studies enrolling 6347 patients were included. Compared with conventional treatment, tailoring antiplatelet failed to reduce all-cause mortality (RR: 0.89, 95% confidence interval [CI]: 0.63-1.24, P = 0.48), MACE (RR: 1.02, 95% CI: 0.92-1.14, P = 0.69), MI (RR: 1.07, 95% CI: 0.95-1.21, P = 0.24), CV death (RR: 0.69, 95% CI: 0.40-1.19, P = 0.09), ST (RR: 0.83, 95% CI: 0.50-1.38, P = 0.23), stroke or TIA (RR: 1.08, 95% CI: 0.55-2.12, P = 0.83), revascularization (RR: 0.96, 95% CI: 0.69-1.33, P = 0.79), and major bleeding events (RR: 0.79, 95% CI: 0.53-1.17, P = 0.24). Compared with traditional antiplatelet treatment, tailoring antiplatelet therapy according to platelet reactivity testing failed to reduce all-cause mortality, MACE, and major bleeding events in patients undergoing PCI.

  1. Prognostic significance of the Centers for Disease Control/American Heart Association high-sensitivity C-reactive protein cut points for cardiovascular and other outcomes in patients with stable coronary artery disease

    NARCIS (Netherlands)

    Sabatine, Marc S.; Morrow, David A.; Jablonski, Kathleen A.; Rice, Madeline Murguia; Warnica, J. Wayne; Domanski, Michael J.; Hsia, Judith; Gersh, Bernard J.; Rifai, Nader; Ridker, Paul M.; Pfeffer, Marc A.; Braunwald, Eugene

    2007-01-01

    Background-Data supporting the prognostic significance of high-sensitivity C-reactive protein (hs-CRP) are derived largely from individuals with no overt coronary artery disease or from patients with acute coronary syndromes. In contrast, the ability of hs-CRP to predict outcomes in patients with st

  2. Depression, C-reactive protein and length of post-operative hospital stay in coronary artery bypass graft surgery patients.

    Science.gov (United States)

    Poole, Lydia; Kidd, Tara; Leigh, Elizabeth; Ronaldson, Amy; Jahangiri, Marjan; Steptoe, Andrew

    2014-03-01

    This study aimed to explore the role of C-reactive protein (CRP) in mediating the association between greater pre-operative depression symptoms and longer post-operative length of stay in patients undergoing coronary artery bypass graft (CABG) surgery. We used a sample of 145 elective CABG patients and measured depression symptoms using the Beck Depression Inventory (BDI) prior to surgery and collected baseline measures of CRP. Participants were followed up during their in-hospital stay to measure early (1-3 days post-surgery) and persistent (4-8 days post-surgery) CRP responses to surgery. We found that compared with participants with low depression symptoms, those with elevated depression symptoms (BDI>10) prior to CABG were at increased odds of a hospital stay of greater than one week (OR 3.51, 95% CI 1.415-8.693, p=0.007) and that greater persistent CRP responses mediated this association. Further work is needed to explore the exact physiological pathways through which depression and CRP interact to affect recovery in CABG patients.

  3. Relationship among soluble CD105,hypersensitive C-reactive protein and coronary plaque morphology:an intravascular ultrasound study

    Institute of Scientific and Technical Information of China (English)

    CUI Song; GE Chang-jiang; LIU Hong; L(U) Shu-zheng; CHEN Yun-dai; HE Guo-xiang; MENG Li-jun; LIU Jian-ping; SONG Zhi-yuan; LIU Xian-liang; SONG Xian-tao

    2008-01-01

    Background Rupture of unstable plaque with subsequent thrombus formation is the common pathophysiological substrate of acute coronary syndrome(ACS).It is of potential significance to explore the blood indexes predicting plaque characteristics.We investigated the relationship among soluble CD105,hypersensitive C-reactive protein(hs-CRP),and coronary plaque morphology.Methods A clinical study from April 2004 to December 2006 was conducted in 130 patients who were divided into 3 groups:56 patients(43.1%)in stable angina(SA)group,52 patients(40.0%)in unstable angina(UA)group and 22 patients(16.9%)in acute myocardial infarction group.The concentrations of soluble CD105 and hs-CRP were measured ln all of the patients by cardioangiography(CAG).Plasma samples of arterial blood were collected prior to the procedure.The levels of soluble CD105 and hs-CRP were measured by enzyme-linked immunosorbent assay (ELISA).Results Unstable and ruptured plaque was found more frequently in patients with acute myocardial infarction and UA.External elastic membrane cross-sectional area(EEM CSA),plaque area,lipid pool area and plaque burden were significantly larger in the ruptured and unstable plaque group.Positive remodeling,thinner fabric-cap,smaller minimal lumen cross-sectional area(MLA),dissection and thrombus were significantly more frequent in the ruptured and unstable plaque group.Remodeling index(RI)was positively correlated with the levels of soluble CD105 in the UA group (r=0.628,P<0.01)and the acute myocardial infarction group(r=0.639,P<0.01).The Ievels of soluble CD105 and hs-CRP were higher in the ruptu red plaque group.Soluble CD105>4.3 ng/ml was used to predict ruptured plaque with a receiver operating characteristic(ROC)curve area of 0.77(95%confidence interval(Cl),66.8%-87.2%),a sensitivity of 72.8%,a specificity of 78.0%and an accuracy of 70.2%(P<0.01),similarly for hs-CRP>5.0 mg/ml with a ROC curve area of 0.70 (95%Cl,59.2%-80.2%),a sensitivity of 70.2%,a

  4. Combination of Fibrinogen and High-sensitivity C-reactive Protein Measurements is Potential in Identification of Acute Coronary Syndrome

    Directory of Open Access Journals (Sweden)

    Djanggan Sargowo

    2015-04-01

    Full Text Available BACKGROUND: Acute myocardial infarction (AMI is one of cardiovascular diseases with high morbidity and mortality rates. Novel biomarkers that can detect accurately acute coronary syndrome (ACS at early stage, are necessary to improve current strategies and/or to identify subjects who are at risk. Fibrinogen and high-sensitivity C-reactive protein (hs-CRP roles in inflammation process could be potential for ACS early detection. This study was conducted to evaluate measurements of fibrinogen and hs-CRP on ACS. METHODS: An analytic observational study with cross sectional approach was conducted on patients with Troponin I positive. After signing informed consent, anamnesis and complete blood count were conducted. Besides that, liver function, renal function, and blood glucose tests were conducted as well. Samples of selected subjects were quantified with enzyme-linked immunosorbent assay (ELISA for Troponin I, fibrinogen and hs-CRP. Then statistical analyses were performed. RESULTS: There were 76 subjects in each ACS and non-ACS groups. ACS group showed significant higher levels of both fibrinogen and hs-CRP compared to Non-ACS group (p=0.000. Among evaluated risk factors, diabetes mellitus (DM (p=0.003 and hypertension (p=0.000 were significantly higher in ACS group than in non-ACS group. Among evaluated clinical factors, blood glucose (p=0.001 and age (p=0.000 were significantly higher in ACS group than in non-ACS group. Combination of fibrinogen and hs-CRP measurements showed the highest sensitivity (75.00%, specificity (80.26%, accuracy (77.63%, positive predictive value (79.19% and negative predictive value (76.25%. CONCLUSIONS: Since fibrinogen and hs-CRP were increased in ACS group and combination of fibrinogen and hs-CRP measurements showed the highest sensitivity, specificity, accuracy, positive predictive value and negative predictive value, we suggest that combination of fibrinogen and hs-CRP measurements could give added value to

  5. Comparative reactivity of the myeloperoxidase-derived oxidants hypochlorous acid and hypothiocyanous acid with human coronary artery endothelial cells.

    Science.gov (United States)

    Lloyd, Mitchell M; Grima, Michael A; Rayner, Benjamin S; Hadfield, Katrina A; Davies, Michael J; Hawkins, Clare L

    2013-12-01

    In the immune response, hypohalous acids are generated by activated leukocytes via the release of myeloperoxidase and the formation of H2O2. Although these oxidants have important bactericidal properties, they have also been implicated in causing tissue damage in inflammatory diseases, including atherosclerosis. Hypochlorous acid (HOCl) and hypothiocyanous acid (HOSCN) are the major oxidants formed by myeloperoxidase under physiological conditions, with the ratio of these oxidants dependent on diet and smoking status. HOCl is highly reactive and causes marked cellular damage, but few data are available on the effects of HOSCN on mammalian cells. In this study, we have compared the actions of HOCl and HOSCN on human coronary artery endothelial cells (HCAEC). HOCl reacts rapidly with the cells, resulting in extensive cell death by both apoptosis and necrosis, with necrosis dominating at higher oxidant doses. In contrast, HOSCN is consumed more slowly, with cell death occurring only by apoptosis. Exposure of HCAEC to HOCl and HOSCN induces changes in mitochondrial membrane permeability, which, in the case of HOSCN, is associated with mitochondrial release of proapoptotic factors, including cytochrome c, apoptosis-inducing factor, and endonuclease G. With each oxidant, apoptosis appears to be caspase-independent, with the inactivation of caspases 3/7 observed, and pretreatment of the cells with the caspase inhibitor Z-VAD-fmk having no effect on the extent of cell death. Loss of cellular thiols, depletion of glutathione, and the inactivation of thiol-dependent enzymes, including glyceraldehyde-3-phosphate dehydrogenase, were seen with both oxidants, though to a much greater extent with HOCl. The ability of myeloperoxidase-derived oxidants to induce endothelial cell apoptosis may contribute to the formation of unstable lesions in atherosclerosis. The results with HOSCN may be particularly significant for smokers, who have elevated plasma levels of SCN(-), the precursor

  6. Relationship between Coronary Risk Factors, C-Reactive Protein, Bone Mineral Density and Carotid Circulation Among Frail Elderly

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    Moatassem S. Amer1, Tamer M. Farid1, Ekrami E. Abdel-rahman1,

    2014-06-01

    Full Text Available Background: Frailty may now be regarded as a geriatric syndrome of decreased reserve and resistance to stressors, resulting from cumulative declines across multiple physiologic systems, causing vulnerability to adverse health outcomes including falls, hospitalisation, institutionalisation and mortality. The inflammatory mediators as C-reactive protein have been associated with the development of the geriatric frailty. Several studies have pointed out increased level of homocystiene in frail elderly Increasing frailty was associated with lower bone mineral density, as both bone mass and muscle strength decrease during ageing and this has also been associated with higher risk of osteoporotic fractures in frail elderly. Objective: To compare frail and non-frail elderly regarding Bone mineral density, carotid circulation and serum levels of Homocysteine, coronary risk factors and CRP. Methods: 104 elderly patients, who were assigned to 2 groups. Group A (52 frail participants: diagnosed by Fried’s criteria as applied by Avila-Funes et al., 2008. Group B (52 non-frail participants.All participants were subjected to the following: through history, physical examination, ADL, IADL assessment, MMSE ,GDS, laboratory investigations including; CRP, homocystiene and total lipid profile, measurement of bone mineral density by DEXA and carotid intima-media thickness by carotid duplex. Results: There was no statistically significant difference in age, sex, among both groups.Frail participants had higher ADL and IADL dependence, higher incidence of depression, cognitive impairment and osteoprosis.They also had higher levels of homocystiene , CRP , CIMT and lower levels of HDL cholesterol. Conclusion: Osteoporosis is more prevalent among frail elderly also frailty is associated with more ADL & IADL dependence, higher GDS scores & lower MMSE score in addition to higher mean level of homocystiene, CRP & triglycerides in addition to low serum HDL & higher CIMT

  7. Soluble urokinase plasminogen activator receptor is in contrast to high-sensitive C-reactive-protein associated with coronary artery calcifications in healthy middle-aged subjects

    DEFF Research Database (Denmark)

    Sørensen, Mette Hjortdal; Gerke, Oke; Eugen-Olsen, Jesper;

    2014-01-01

    OBJECTIVE: The main objective of this study was to investigate the association between two markers of low-grade inflammation; soluble urokinase plasminogen activator receptor (suPAR) and high-sensitive C-reactive protein (hs-CRP); and coronary artery calcification (CAC) score detected by cardiac...... computed tomography (CT) scan. DESIGN: A cross sectional study of 1126 randomly sampled middle-aged men and women. METHODS: CAC score was measured by a non-contrast cardiac CT scan and total 10-year cardiovascular mortality risk was estimated using the Systematic Coronary Risk Evaluation (SCORE). Plasma...... samples were analysed for suPAR and hs-CRP. The association of suPAR and hs-CRP to CAC was evaluated by logistic regression analyses adjusting for categorised SCORE. The additive effect of suPAR to SCORE was evaluated by comparing area under curve (AUC) and net reclassification improvement (NRI). RESULTS...

  8. 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.

  9. Usefulness of baseline lipids and C-reactive protein in women receiving menopausal hormone therapy as predictors of treatment-related coronary events.

    Science.gov (United States)

    Bray, Paul F; Larson, Joseph C; Lacroix, Andrea Z; Manson, Joann; Limacher, Marian C; Rossouw, Jacques E; Lasser, Norman L; Lawson, William E; Stefanick, Marcia L; Langer, Robert D; Margolis, Karen L

    2008-06-01

    Blood lipids and high-sensitivity C-reactive protein (hs-CRP) are altered by hormone therapy. The goal of the present study was to determine whether lipids and hs-CRP have predictive value for hormone therapy benefit or risk for coronary heart disease events in postmenopausal women without previous cardiovascular disease. A nested case-control study was performed in the Women's Health Initiative hormone trials. Baseline lipids and hs-CRP were obtained from 271 incident patients with coronary heart disease (cases) and 707 controls. In a combined trial analysis, favorable lipid status at baseline tended to predict better coronary heart disease outcomes when using conjugated equine estrogen (CEE) with or without medroxyprogesterone acetate (MPA). Women with a low-density lipoprotein (LDL)/high-density lipoprotein (HDL) cholesterol ratio disease when using CEE with or without MPA (odds ratio 0.60, 95% confidence interval 0.34 to 1.06), whereas women with an LDL/HDL cholesterol ratio > or =2.5 had increased risk of coronary heart disease (odds ratio 1.73, 95% confidence interval 1.18 to 2.53, p for interaction = 0.02). Low hs-CRP added marginally to the value of LDL/HDL ratio disease benefit on hormone therapy. In conclusion, postmenopausal women with undesirable lipid levels had excess coronary heart disease risk when using CEE with or without MPA. However, women with favorable lipid levels, especially LDL/HDL cholesterol ratio disease with CEE with or without MPA irrespective of hs-CRP.

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

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    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.

  11. 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.

  12. Comparision of high sensitivity C-reactive protein and matrix metalloproteinase 9 in patients with unstable angina between with and without significant coronary artery plaques

    Institute of Scientific and Technical Information of China (English)

    WANG Li-xin; L(U) Shu-zheng; ZHANG Wei-jun; SONG Xian-tao; CHEN Hui; ZHANG Li-jie

    2011-01-01

    Background Inflammation within vulnerable coronary plaques may cause unstable angina by promoting rupture and erosion. C-reactive protein (CRP) is the most reliable and accessible test method for clinical use for identifying coronary artery disease event. Matrix metalloproteinase 9 (MMP-9) is highly over-expressed in the vulnerable regions of a plaque.Our aim was to evaluate the plasma levels of MMP-9 and hsCRP in subjects with both unstable angina and coronary plaques, as well as in those with unstable angina without coronary plaques.Methods Patients with newly diagnosed unstable angina pectoris from clinical presentation and ECG, who were undergoing coronary angiography from April 2007 to April 2009, were included in this study. A total of 170 subjects were enrolled in the study. Before angiography, the baseline clinical data (mainly including conventional risk factors) was collected.These patients were divided into two groups, a non-plaque group (G1) which included 55 patients with no significant stenosis or less than 20% stenosis in at least one of the major coronary artery branches, and a plaque group (G2) which included 115 patients with at least one of the major coronary artery branches unstable angina pectoris with at least 50% stenosis of one major coronary artery. The patients presenting with calcified nodules of a major coronary artery were excluded from this study.We examined the serum levels of MMP-9 for all cases by multi-effect enzyme-linked immunosorbent assay.Results There was a significant difference in the serum levels of MMP-9 between the two groups (P<0.001). The percentage of patients with hypertension, diabetes and current smokers were significantly different between the two groups (P=0.034, P=0.031, and P=0.044 respectively). The univariate Logistic regression analyses of risk factors showed that smoking was the main risk factor for angina in the non-plaque group with the OR being 1.95 (95% Cl 1.02-3.75).Hypertension, diabetes mellitus

  13. Coronary flow and reactivity, but not arrhythmia vulnerability, are affected by cardioplegia during cardiopulmonary bypass in piglets

    DEFF Research Database (Denmark)

    Liuba, Petru; Johansson, Sune; Pesonen, Erkki;

    2013-01-01

    Background: Surgery under cardiopulmonary bypass (CPB) is still associated with significant cardiovascular morbidity in both pediatric and adult patients but the mechanisms are not fully understood. Abnormalities in coronary flow and function have been suggested to play an important role. Prior...... velocity (cPFV) rose significantly after surgery especially in the cardioplegia group (p0.4). There was no difference in systolic myocardial function between groups at any time point.Conclusion: In piglets, CPB with cardioplegia was associated with profound abnormalities in coronary vasomotor tone...

  14. Microvascular inflammation in atherosclerosis

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    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.

  15. Effect of the rs2259816 polymorphism in the HNF1A gene on circulating levels of c-reactive protein and coronary artery disease (the ludwigshafen risk and cardiovascular health study

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    Renner Wilfried

    2010-11-01

    Full Text Available Abstract Background C-reactive protein is a well established marker of inflammation and has been used to predict future cardiovascular disease. It is still controversial if it plays an active role in the development of cardiovascular disease. Recently, polymorphisms in the gene for HNF1α have been linked to the levels of C-reactive protein and coronary artery disease. Methods We investigated the association of the rs2259816 polymorphism in the HNF1A gene with the circulating level of C-reactive protein and the hazard of coronary artery disease in the LURIC Study cohort. Results Compared to CC homozygotes, the level of C-reactive protein was decreased in carriers of at least one A-allele. Each A-allele decreased CRP by approximately 15%. The odds ratio for coronary artery disease was only very slightly increased in carriers of the A-allele and this association did not reach statistical significance. Conclusions In the LURIC Study cohort the A-allele of rs2259816 is associated with decreased CRP but not with coronary artery disease.

  16. Joint detection of troponin T,high sensitivity C-reactive protein,N-terminal probrain natriuretic peptide applied in the diagnosis of acute coronary syndrome for elderly patients

    Institute of Scientific and Technical Information of China (English)

    赵月霞

    2012-01-01

    Objective To investigate the value of the joint detection of Troponin T(TnT) ,highsensitivity C-reactive protein (hs-CRP) and N-terminal probrain natriuretic peptide(NT-proBNP) for the clinical diagnosis of acute coronary syndrome(ACS) in elderly patients.

  17. The Effect of Aerobic Interval Training and Massage Therapy on C-Reactive Protein and Cardiorespiratory Fitness in Cardiovascular Patients after Coronary Artery Bypass Graft

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    Bahare Sheikhsaraf

    2016-04-01

    Full Text Available The purpose of this study was to investigate the effects of an 8 week period of aerobic interval training and massage therapy on changes in C-reactive protein (CRP level and cardiorespiratory fitness in cardiovascular patients after coronary artery bypass graft. The study population consisted of patients who had undergone a coronary artery bypass graft and at least one month had passed since their surgery. 60 patients met the study inclusion criteria and were willing to cooperate; they were divided randomly into three groups (n = 20 as follows; interval, massage therapy and a control. Subjects in groups taking interval training and massage therapy were administered three sessions per week for eight weeks. 48 hours before and after eight weeks of exercise, subjects were measured for peak oxygen consumption and blood samples were taken. Results of the present study show that 8-week programs of regular exercise and massage therapy resulted in significant reduction of CRP of 42% and 25% respectively (P<0.05. Peak oxygen consumption values after eight weeks of regular exercise showed a significant increase (22% in interval exercise and 17% in massage therapy (P<0.05. In general, these findings show that 8-week programs of aerobic interval training and massage therapy significantly reduced serum CRP value and caused a significant increase in peak oxygen consumption in patients with coronary artery bypass graft. These changes can be effective for prevention of sudden death and cardiovascular problems after bypass surgery. Also, interval training was more effective on reducing CRP and increasing peak oxygen consumption than massage therapy.

  18. C-reactive protein for predicting prognosis and its gender-specific associations with diabetes mellitus and hypertension in the development of coronary artery spasm.

    Science.gov (United States)

    Hung, Ming-Jui; Hsu, Kuang-Hung; Hu, Wei-Syun; Chang, Nen-Chung; Hung, Ming-Yow

    2013-01-01

    While hypertension is negatively associated with coronary artery spasm (CAS), scarce data are available on diabetes mellitus in relation to CAS. In addition, outcome prediction in patients with CAS is challenging due to the lack of appropriate biomarkers. Therefore, we sought to identify the roles that gender, high-sensitivity C-reactive protein (hs-CRP), diabetes mellitus and hypertension play in CAS development and prognosis. Patients (350 women and 547 men) undergoing diagnostic coronary angiography with or without proven CAS but without obstructive stenosis were evaluated at long-term follow-up (median 102 months). Diabetic women and diabetic men with low hs-CRP levels had a low and high risk of CAS (odds ratio [OR]: 0.16, 95% confidence interval [CI]: 0.01-1.88 and OR: 5.02, 95% CI: 1.03-24.54, respectively). The ORs of CAS in both women and men with the highest hs-CRP tertile (>3 mg/L) reduced from 4.41 to 1.45 and 2.98 to 1.52, respectively, if they had diabetes mellitus, and from 9.68 to 2.43 and 2.60 to 1.75, respectively, if they had hypertension. Hypertension had a more negative effect on CAS development in diabetic than non-diabetic women, which was not observed in men. The highest hs-CRP tertile was an independent predictor of adverse outcomes. Patients with the highest hs-CRP tertile had more coronary events than patients with the lowest hs-CRP tertitle (p = 0.021, log-rank test). Diabetes mellitus contributes to CAS development in men with low hs-CRP levels, but not in women. There are negative effects of diabetes mellitus and hypertension on CAS development in patients with high hs-CRP levels and especially in women. Elevated hs-CRP level independently predicts adverse outcomes.

  19. Gender-Specific Prognosis and Risk Impact of C-Reactive Protein, Hemoglobin and Platelet in the Development of Coronary Spasm

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    Ming-Yow Hung, Kuang-Hung Hsu, Wei-Syun Hu, Nen-Chung Chang, Chun-Yao Huang, Ming-Jui Hung

    2013-01-01

    Full Text Available Background: Scarce data are available on hemoglobin and platelet in relation to coronary artery spasm (CAS development. We sought to determine the roles that high-sensitivity C-reactive protein (hs-CRP, hemoglobin and platelet play in CAS patients.Methods: Patients (337 women and 532 men undergoing coronary angiography with or without CAS but without obstructive coronary artery disease were evaluated during a 12-year period.Results: Among women with high hemoglobin levels, the odds ratios (OR from the lowest (<1 mg/l to the highest tertiles (>3 mg/l of hs-CRP were 1.21, 2.15, and 5.93 (p=0.009. In women with low hemoglobin levels, an elevated risk was found from the middle to the highest tertiles of hs-CRP (OR 0.59 to 3.85 (p=0.004. This relationship was not observed in men. In men, platelet count was the most significant risk factor for CAS (p=0.004. The highest likelihood of developing CAS was found among women with the highest hs-CRP tertile and low platelet counts (OR 8.77; 95% confidence interval [CI] 2.20-35.01 and among men with the highest hs-CRP tertile and high platelet counts (OR 4.58; 95% CI 0.48-43.97. Neither hemoglobin level nor platelet count was associated with frequent recurrent angina in both genders with CAS whereas death and myocardial infarction were rare.Conclusions: There are positive interactions among hs-CRP, hemoglobin and platelet in women with this disease, but not in men. While hemoglobin is a modifier in CAS development in women, platelet count is an independent risk factor for men. Both women and men have good prognosis of CAS.

  20. Senescence Marker Protein-30 (SMP30 Deficiency Impairs Myocardium-Induced Dilation of Coronary Arterioles Associated with Reactive Oxygen Species

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    Hiroyuki Mizukami

    2013-04-01

    Full Text Available Senescence marker protein-30 (SMP30 decreases with aging. Mice with SMP30 deficiency, a model of aging, have a short lifespan with increased oxidant stress. To elucidate SMP30’s effect on coronary circulation derived from myocytes, we measured the changes in the diameter of isolated coronary arterioles in wild-type (WT mice exposed to supernatant collected from isolated paced cardiac myocytes from SMP30 KO or WT mice. Pacing increased hydrogen peroxide in myocytes, and hydrogen peroxide was greater in SMP30 KO myocytes compared to WT myocytes. Antimycin enhanced and FCCP (oxidative phosphorylation uncoupler in mitochondria decreased superoxide production in both groups. Addition of supernatant from stimulated myocytes, either SMP30 KO or WT, caused vasodilation. The degree of the vasodilation response to supernatant was smaller in SMP30 KO mice compared to WT mice. Administration of catalase to arterioles eliminated vasodilation in myocyte supernatant of WT mice and converted vasodilation to vasoconstriction in myocyte supernatant of SMP30 KO mice. This vasoconstriction was eliminated by olmesartan, an angiotensin II receptor antagonist. Thus, SMP30 deficiency combined with oxidant stress increases angiotensin and hydrogen peroxide release from cardiac myocytes. SMP30 plays an important role in the regulation of coronary vascular tone by myocardium.

  1. Preprocedural C-Reactive Protein Predicts Outcomes after Primary Percutaneous Coronary Intervention in Patients with ST-elevation Myocardial Infarction a systematic meta-analysis

    Science.gov (United States)

    Mincu, Raluca-Ileana; Jánosi, Rolf Alexander; Vinereanu, Dragos; Rassaf, Tienush; Totzeck, Matthias

    2017-01-01

    Risk assessment in patients with acute coronary syndromes (ACS) is critical in order to provide adequate treatment. We performed a systematic meta-analysis to assess the predictive role of serum C-reactive protein (CRP) in patients with ST-segment elevation myocardial infarction (STEMI), treated with primary percutaneous coronary intervention (PPCI). We included 7 studies, out of 1,033 studies, with a total of 6,993 patients with STEMI undergoing PPCI, which were divided in the high or low CRP group, according to the validated cut-off values provided by the corresponding CRP assay. High CRP values were associated with increased in-hospital and follow-up all-cause mortality, in-hospital and follow-up major adverse cardiac events (MACE), and recurrent myocardial infarction (MI). The pre-procedural CRP predicted in-hospital target vessel revascularization (TVR), but was not associated with acute/subacute and follow-up in-stent restenosis (ISR), and follow-up TVR. Thus, pre-procedural serum CRP could be a valuable predictor of global cardiovascular risk, rather than a predictor of stent-related complications in patients with STEMI undergoing PPCI. This biomarker might have the potential to improve the management of these high-risk patients.

  2. Tissue-type plasminogen activator and C-reactive protein in acute coronary heart disease. A nested case-control study

    DEFF Research Database (Denmark)

    Gram, J; Bladbjerg, E-M; Møller, L

    2000-01-01

    OBJECTIVES: To study the importance of inflammation and fibrinolysis for evolution of ischaemic heart disease in a cohort of initially healthy subjects. DESIGN: Nested case-control study. Follow-up periods 7-15 years. SUBJECTS: Included in the study were 133 cases with coronary heart disease...... and 258 controls. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Subjects with ischaemic heart disease identified in 1991 by the Danish National Hospital Register. Protein concentration of C-reactive protein (CRP) and tissue-type plasminogen activator (t-PA) were measured with ELISA methods in stored serum...... samples. RESULTS: CRP and t-PA concentrations were both significantly higher in cases than in controls (P difference between cases and controls for CRP and t-PA was present in both men (CRP: P = 0.022; t-PA: P = 0.001) and women (CRP: P = 0.013; t-PA: P = 0...

  3. Positive correlation between uric acid and C-reactive protein serum level in healthy individuals and patients with acute coronary syndrome

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    Emina Spahić

    2015-08-01

    Full Text Available Aim To assess serum levels and correlation between uric acid (UA and C-reactive protein (CRP in acute coronary syndrome (ACS and apparently healthy individuals. Methods The cross-sectional study included 116 examinees of age 44 to 83 years, distributed in two groups: 80 ACS patients including 40 with acute myocardial infarction (AMI, and 40 with unstable angina pectoris (UAP, and 36 apparently healthy (control group individuals. Patients with ACS were hospitalized at the Cardiology Clinic, Clinical Centre Sarajevo in the period October- December 2012. Laboratory analyses were conducted by standard methods. The accepted statistical significance level was p0.05. Conclusion The correlation between CRP and UA in the patients with ACS indicates the association of oxidative stress and inflammation intensity in damaged cardiomyocytes. Correlation between UA and CRP in apparently healthy individuals indicates a possible role of UA as a marker of low-grade inflammation and its potential in risk assessment in cardiovascular diseases.

  4. Current status of high on-treatment platelet reactivity in patients with coronary or peripheral arterial disease:Mechanisms,evaluation and clinical implications

    Institute of Scientific and Technical Information of China (English)

    Stavros Spiliopoulos; Georgios Pastromas

    2015-01-01

    Antiplatelet therapy with aspirin or clopidogrel or both is the standard care for patients with proven coronary or peripheral arterial disease,especially those undergoing endovascular revascularization procedures. However,despite the administration of the antiplatelet regiments,some patients still experience recurrent cardiovascular ischemic events. So far,it is well documented by several studies that in vitro response of platelets may be extremely variable. Poor antiplatelet effect of clopidogrel or high on-treatment platelet reactivity(HTPR) is under investigation by numerous recent studies. This review article focuses on methods used for the ex vivo evaluation of HTPR,as well as on the possible underlying mechanisms and the clinical consequences of this entity. Alternative therapeutic options and future directions are also addressed.

  5. 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.

  6. 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.

  7. 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...

  8. Pravastatin-induced improvement in coronary reactivity and circulating ATP and ADP levels in young adults with type 1 diabetes

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    Tuomas Oskari Kiviniemi

    2012-08-01

    Full Text Available Aims: Extracellular ATP and ADP regulate diverse inflammatory, prothrombotic and vasoactive responses in the vasculature. Statins have been shown to modulate their signaling pathways in vitro. We hypothesized that altered intravascular nucleotide turnover modulates vasodilation in patients with type 1 diabetes (T1DM, and this can be partly restored with pravastatin therapy. Methods: In this randomized double blind study, plasma ATP and ADP levels and echocardiography-derived coronary flow velocity response to cold pressor test (CPT were concurrently assessed in 42 normocholesterolemic patients with T1DM (age 30±6 years, LDL cholesterol 2.5±0.6 mmol/L before and after four-month treatment with pravastatin 40 mg/day or placebo (n=22 and n=20, respectively, and in 41 healthy control subjects. Results: Compared to controls, T1DM patients had significantly higher concentrations of ATP (p<0.01 and ADP (p<0.01 and these levels were partly restored after treatment with pravastatin (p=0.002 and p=0.007, respectively, but not after placebo (p=0.06 and p=0.14, respectively. Coronary flow velocity acceleration was significantly lower in T1DM patients compared to control subjects, and it increased from pre- to post-intervention in the pravastatin (p=0.02, but not in placebo group (p=0.15. Conclusions: Pravastatin treatment significantly reduces circulating ATP and ADP levels of T1DM patients, and concurrently improves coronary flow response to CPT. This study provides a novel insight in purinergic mechanisms involved in pleiotropic effects of pravastatin.

  9. C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis

    DEFF Research Database (Denmark)

    Kaptoge, Stephen; Di Angelantonio, Emanuele; Lowe, Gordon

    2010-01-01

    Associations of C-reactive protein (CRP) concentration with risk of major diseases can best be assessed by long-term prospective follow-up of large numbers of people. We assessed the associations of CRP concentration with risk of vascular and non-vascular outcomes under different circumstances....

  10. EVALUATION OF COST-EFFECTIVENESS OF PLATELET REACTIVITY ANALYSIS USING THE VERIFYNOW P2Y12 ASSAY IN PATIENTS AFTER ACUTE CORONARY SYNDROME

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    A. V. Rudakova

    2015-09-01

    Full Text Available Dual antiplatelet therapy, including clopidogrel and aspirin, in a significant share of patients after acute coronary syndrome (ACS is characterized by high level of platelet reactivity, which is associated with an increased incidence of cardiovascular events. Perhaps it will make reasonable the prescription of new antiplatelet drugs, particularly the combination of ticagrelor with aspirin.Aim. To assess the cost-effectiveness of VerifyNow P2Y12 platelet reactivity testing in patients after ACS.Material and methods. The analysis was performed for patients aged 55 years after ACS by modeling based on the results of the PLATO trial considering Russian epidemiological data. The time horizon of simulation was 5 years. It was assumed that the patients were receiving either generic clopidogrel or ticagrelor for 1 year, or before maintenance treatment VerifyNow P2Y12 assay had been performed, and the patients with platelet reactivity index >230 24-48 hours after ACS were receiving ticagrelor and the remaining patients - generic clopidogrel. It was expected that after 1 year the patients would discontinue treatment with clopidogrel or ticagrelor, and hereafter additional therapeutic effect of their use would be absent. The costs of antiplatelet agents in the reference case corresponded to the weighted average price of public procurement in 2013 in Russia. The costs of treatment of complications corresponded to the compulsory health insurance rates for St. Petersburg in 2014. The cost and life expectancy were discounted at 3.5% per year.Results. The platelet reactivity test and the prescription by its results of the combination of clopidogrel plus aspirin or ticagrelor plus aspirin can prevent 5 myocardial infarction and 6 deaths per 1000 patients additionally as compared with the prescription of clopidogrel plus aspirin combination to all patients. The costs for one additional year of life as compared with the combination of clopidogrel plus aspirin

  11. EVALUATION OF COST-EFFECTIVENESS OF PLATELET REACTIVITY ANALYSIS USING THE VERIFYNOW P2Y12 ASSAY IN PATIENTS AFTER ACUTE CORONARY SYNDROME

    Directory of Open Access Journals (Sweden)

    A. V. Rudakova

    2015-01-01

    Full Text Available Dual antiplatelet therapy, including clopidogrel and aspirin, in a significant share of patients after acute coronary syndrome (ACS is characterized by high level of platelet reactivity, which is associated with an increased incidence of cardiovascular events. Perhaps it will make reasonable the prescription of new antiplatelet drugs, particularly the combination of ticagrelor with aspirin.Aim. To assess the cost-effectiveness of VerifyNow P2Y12 platelet reactivity testing in patients after ACS.Material and methods. The analysis was performed for patients aged 55 years after ACS by modeling based on the results of the PLATO trial considering Russian epidemiological data. The time horizon of simulation was 5 years. It was assumed that the patients were receiving either generic clopidogrel or ticagrelor for 1 year, or before maintenance treatment VerifyNow P2Y12 assay had been performed, and the patients with platelet reactivity index >230 24-48 hours after ACS were receiving ticagrelor and the remaining patients - generic clopidogrel. It was expected that after 1 year the patients would discontinue treatment with clopidogrel or ticagrelor, and hereafter additional therapeutic effect of their use would be absent. The costs of antiplatelet agents in the reference case corresponded to the weighted average price of public procurement in 2013 in Russia. The costs of treatment of complications corresponded to the compulsory health insurance rates for St. Petersburg in 2014. The cost and life expectancy were discounted at 3.5% per year.Results. The platelet reactivity test and the prescription by its results of the combination of clopidogrel plus aspirin or ticagrelor plus aspirin can prevent 5 myocardial infarction and 6 deaths per 1000 patients additionally as compared with the prescription of clopidogrel plus aspirin combination to all patients. The costs for one additional year of life as compared with the combination of clopidogrel plus aspirin

  12. 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...

  13. 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...

  14. 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.

  15. 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

  16. 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.

  17. 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...

  18. 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...

  19. High residual platelet reactivity during dual antiplatelet therapy, found by optical aggregometry and the rate of atherothrombotic complications after coronary artery stenting in patients with ischemic heart disease in clinical practice

    OpenAIRE

    N. F. Puchinyan; N. V. Furman; P. V. Dolotovskaya; L. L. Malinova

    2016-01-01

    Aim. To study the prevalence of high residual platelet reactivity (HRPR) during the dual antiplatelet therapy (DAT) with acetylsalicylic acid (ASA) and clopidogrel by optical aggregometry in patients with ischemic heart disease (IHD) after percutaneous transluminal coronary angioplasty (PTCA) in clinical practice, as well as to determine its value for the prediction of clinical course and outcome of disease.Material and methods. Patients after PTCA and during DAT were included into the study....

  20. CMR of microvascular obstruction and hemorrhage in myocardial infarction

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    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.

  1. Relationship Between gamma-Glutamyltransferase (gamma-GT with High Sensitive C-Reactive Protein (hs-CRP, Oxidized (Ox-LDL and Glutathione Peroxidase (GPx on Coronary Heart Disease (CHD Patient

    Directory of Open Access Journals (Sweden)

    Marissa Arifin

    2009-08-01

    Full Text Available BACKGROUND: Recent clinical studies have suggested that γ-glutamyltransferase (γ-GT can trigger oxidative stress within the plaque. This study aimed to investigate whether serum γ-GT might be as a risk factor of coronary heart disease (CHD, and measure the associations of serum γ-GT with high sensitive C-Reactive Protein (hs-CRP, Oxidized LDL (Ox-LDL and Glutathione Peroxidase (GPx. METHODS: This study recruited 48 patients aged 30-70 year who underwent coronary angiography at Haji Adam Malik Medical Center at Medan between February and April 2008 and who presented at least one coronary stenosis of >50% of the luminar diameter. The sample subjects were consecutively selected. RESULTS: γ-Glutamyltransferase was positively associated (r=0.546 with hs-CRP as a marker of chronic inflammation after careful adjustment for other established risk factors in CHD patient. But, there was no significant difference between γ-GT in male and female patients. Further, there were no correlations between γ-GT and Ox-LDL and GPx. Ratio of γ-GT/GPx was measured as well, and it was associated with hs-CRP. CONCLUSIONS: Ratio of γ-GT/GPx was associated with inflammation process in coronary heart disease patients. KEYWORDS: γ-glutamyltransferase (γ-GT, inflammation, oxidative stress, coronary heart disease.

  2. A meta-analysis of the effects of statins on serum C-reactive protein in Chinese population with coronary heart disease or hyperlipidemia

    Institute of Scientific and Technical Information of China (English)

    HAO PanPan; CHEN YuGuo; WANG XingLi; XU Feng; WANG JiaLi; ZHANG Yun

    2009-01-01

    There is little doubt that statins reduce cardiovascular events more than what the lipid lowering effect can account for. Additional mechanisms have been postulated including the anti-inflammatory effects manifested by reduced C-reactive protein (CRP). It is not known, however, whether statins can decrease CRP in Chinese population. The aim of this study is to investigate the effects of statins on serum CRP in Chinese patients with coronary heart disease (CHD) or hyperlipidemia. Trials were retrieved through Medline (1980 to May, 2009), bibliographies, and the author's reference files limited to English-language articles. Data were extracted and meta-analysis was performed. Analysis showed statis-tically significant reduction in CRP after statin treatment (weighted mean difference [WMD] = -0.73, 95% confidence interval [Cl] = [-0.80, -0.66], P < 0.00001) and lower CRP after statin treatment than non-statin routine treatment ([WMD] = -0.52, 95% Cl [-0.86, -0.18], P = 0.002). In conclusion, statins significantly reduce serum CRP in Chinese population, which may contribute to statin-induced reduction in the cardiovascular risk in addition to the lipid lowering effect.

  3. Assessment of Diagnostic Efficiency of Lipoprotein (a, Homocysteine, High Sensitive C-Reactive Protein and Fibrinogen in Patients with Coronary Artery Disease

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    Ebru Dundar Yenilmez

    2013-08-01

    Full Text Available Backround: To evaluate the diagnostic value of major and other risk factors as lipoprotein (Lp (a, homocysteine (Hcy, high sensitive C-reactive protein (hs-CRP and fibrinogen in CAD patients. Methods: A total of 223 subjects (118 patients and 105 controls were included in the study according to their coronary angiographic results. Lipoprotein (a, Hcy, hs-CRP and fibrinogen levels were measured using immunoturbidometric, florescent polarization immunoassay and nefelometric methods, respectively. Fasting glucose and lipid parameters, except low density lipoprotein cholesterol (LDL-C, are determined by enzymatic colorimetric methods and the LDL-C levels were calculated by the Fridewald formula. Results: Logistic regression analysis showed that when the biochemical variables in placed in a model, the most important variables were Lp (a, Hcy, hs-CRP and fibrinogen. We showed that each unit of Lp (a, Hcy, hs-CRP and fibrinogen increases the risk of CAD 1.029, 1.177, 1.027 and 1.013 fold, respectively. Among these, fibrinogen level was the most sensitive and efficient parameter in prediction of CAD. Conclusion: Although Lp (a, Hcy, hs-CRP and fibrinogen are independent risk factors for CAD, fibrinogen was the most important one. Fibrinogen can be used as a reliable risk factor for CAD in clinical practice. [Cukurova Med J 2013; 38(4.000: 559-566

  4. 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.

  5. 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.

  6. 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...

  7. 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

  8. 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.

  9. "Poor man's risk factor": correlation between high sensitivity C-reactive protein and socio-economic class in patients of acute coronary syndrome.

    Science.gov (United States)

    Sethi, Rishi; Puri, Aniket; Makhija, Aman; Singhal, A; Ahuja, A; Mukerjee, S; Dwivedi, S K; Narain, V S; Saran, R K; Puri, V K

    2008-01-01

    Inflammation has been proposed as one of the factors responsible for the development of coronary artery disease (CAD) and high sensitivity C-reactive protein (hs CRP) at present is the strongest marker of inflammation. We did a study to assess the correlation of hs-CRP with socio-economic status (SES) in patients of CAD presenting as acute coronary syndrome (ACS). Baseline hs-CRP of 490 patients of ACS was estimated by turbidimetric immunoassay. Patients were stratified by levels of hs-CRP into low (3 mg/L) groups and in tertiles of 0-0.39 mg/L, 0.4-1.1 mg/L and >1.1 mg/L, respectively. Classification of patient into upper (21.4%), middle (45.37 percent) and lower (33.3%) SES was based on Kuppuswami Index which includes education, income and profession. Presence or absence of traditional risk factors for CAD diabetes, hypertension, dyslipidemia and smoking was recorded in each patient. Mean levels of hs-CRP in lower, middle and upper SES were 2.3 +/- 2.1 mg/L, 0.8 +/- 1.7 mg/L and 1.2 +/- 1.5 mg/L, respectively. hs-CRP levels were significantly higher in low SES compared with both upper SES (p = 0.033) and middle SES (p = 0.001). Prevalence of more than one traditional CAD risk factors was seen in 13.5%, 37.5% and 67.67 percent; in patient of lower, middle and upper SES. It was observed that multiple risk factors had a linear correlation with increasing SES. Of the four traditional risk factors of CAD, smoking was the only factor which was significantly higher in lower SES (73%) as compared to middle (51.67 percent;) and upper (39.4%) SES. We found that 62.3%, 20.8% and 26.5% patients of low, middle and upper SES had hs-CRP values in the highest tertile. Median value of the Framingham risk score in low, middle and upper SES as 11, 14 and 18, respectively. We observed that at each category of Framingham risk, low SES had higher hs-CRP. We conclude from our study that patient of lower SES have significantly higher levels of hs-CRP despite the fact that they have

  10. Microalbuminuria and C-reactive protein as a predictor of coronary artery disease in patients of acute chest pain.

    Science.gov (United States)

    Sharma, Smita; Ghalaut, Veena Singh; Dixit, Ramakant; Kumar, Sanjeev; George, P Jacob

    2013-03-01

    Microalbuminuria is a risk factor for cardiovascular disease. It is gaining importance as a marker of atherogenic milieu and indicates the target organ damage and can be a valuable tool in screening and identification of patients with cardiovascular disease. Markers of inflammation, such as C-reactive protein (CRP), were found to be related to cardiovascular disease (CVD) events in patients with chest pain. In addition, recent studies have shown that, in the case of atherosclerosis, increased levels of CRP, reflects inflammatory condition of vessel wall. In the present study, CRP and microalbuminuria were estimated in patients of acute chest pain. The patients were divided into two study groups (gp-1 patients of chest pain with CVD and gp-2 patients of chest pain of causes other than CVD) along with one healthy control group. It was found that microalbuminuria was higher in CVD patients (RR = 6.250,95% CI 2.346-16.45,P microalbuminuria were also higher in gp-1 (CVD) patients as compared to other two groups. Therefore, CRP and microalbuminuria can be used as important biomarkers in screening CVD.

  11. Combination of high-sensitivity C-reactive protein and homocysteine may predict an increased risk of coronary artery disease in Korean population

    Institute of Scientific and Technical Information of China (English)

    CHO Doo-Yeoun; KIM Kyu-Nam; KIM Kwang-Min; LEE Duck-Joo; KIM Bom-Taeck

    2012-01-01

    Background The association of emerging biomarkers such as high-sensitivity C-reactive protein (hs-CRP),homocysteine and fibrinogen with the risk of coronary artery disease (CAD) is still uncertain in Asian population including Koreans and little is known about the combined effect of biomarkers on the risk of CAD.Methods A total of 10 650 subjects (6538 men and 4112 women) were enrolled in this study.A 10-year CAD risk was calculated using Framingham risk score modified by the National Cholesterol Education Program (NCEP) Adult Treatment Panel Ⅲ (ATP Ⅲ ) and levels of circulating hs-CRP,homocysteine and fibrinogen were measured using validated assays.Results The 10-year CAD risk gradually augmented with increase in the circulating levels of hs-CRP,homocysteine and fibrinogen.For the highest quartile of hs-CRP,odds ratio (OR) of high-risk for CAD (10-year risk ≥20%) compared with the lowest quartile was 3.97 (95% C/:2.51-6.29).For homocysteine and fibrinogen,ORs in the highest quartile compared to the lowest quartile were 5.10 (95% Cl:3.05-8.53,P <0.001) and 1.46 (95% Cl:0.69-3.11,P=0.325),respectively.OR of high-risk for CAD in both the highest quartile of hs-CRP and homocysteine was 9.05 (95% CI:5.30-15.45) compared with the below median of hs-CRP and homocysteine.Conclusions The present study demonstrated that hs-CRP and homocysteine are well associated with the 10-year CAD risk estimated using NCEP ATP Ⅲ in Koreans and combination of hs-CRP and homocysteine can have strong synergyin predicting the development of CAD.

  12. Effect of Walnut Consumption on Serum Lipid Profiles, High-Sensitivity C-Reactive Protein and Nitric Oxide in Patients With Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Kalantarian

    2015-02-01

    Full Text Available Background Coronary artery disease (CAD is one of the major causes of death worldwide. There is a direct relationship between increased levels of blood cholesterol, triglycerides (TG, low density lipoproteins (LDL, high density lipoproteins (HDL, nitric oxide (NO, and high sensitivity C-reactive protein (hs-CRP and the CAD. Walnut may reduce these factors and consequently decrease the risk of CAD. Objectives The aim of this study was to evaluate the effect of walnut consumption on TG, LDL, cholesterol, HDL, NO, and hs-CRP in patients with CAD and healthy people. Patients and Methods In this randomized crossover clinical trial, 70 patients with CAD were divided into two groups: case and control groups. The patients were given 40 g walnuts daily for 4 weeks. After 4 weeks, the TG, LDL, cholesterol, HDL, NO and hs-CRP levels were measured. The experiment was also carried out on healthy people (3 groups with normal range of lipid. The LDL, HDL, cholesterol, and hs-CRP levels were measured using commercially available kits. The nitric oxide level was measured using the Griess reaction method. Results The cholesterol and LDL levels decreased significantly from 202.43 to 187.46 and 123.80 to 108.63 mmol/L (7.9% and 13.9 %, respectively in healthy subjects after the treatment (P < 0.01. In the experimental group, there was no significant difference in cholesterol (P = 0.110 and LDL levels (P = 0.176 before and after the treatment. Moreover, no significant difference was observed in other parameters between the two groups. Conclusions The walnut consumption did not affect cholesterol levels in patients with CAD; however, it might be administered as an agent for reducing the cholesterol, which is one of the risk factors associated with CAD.

  13. Elevated levels of oxidized low-density lipoprotein correlate positively with C-reactive protein in patients with acute coronary syndrome.

    Science.gov (United States)

    Zhang, Ya-chen; Wei, Jing-jing; Wang, Fei; Chen, Man-tian; Zhang, Mao-zhen

    2012-03-01

    The relationship between oxidized low-density lipoprotein (Ox-LDL) and C-reactive protein (CRP) in patients with acute coronary syndrome (ACS) is unknown. We, therefore, measured serum levels of Ox-LDL and high-sensitivity (hs)-CRP in 90 ACS patients, 45 stable angina pectoris (SAP) patients, and 66 healthy controls using sandwich ELISA. ACS patients were subdivided into: (1) acute myocardial infarction (AMI; n = 45); (2) unstable angina pectoris (UAP; n = 45) groups. In AMI patients, Ox-LDL (177.5 mmol/l) and hs-CRP (25.40 mg/l) levels were significantly higher (P LDL:107.5 mmol/l, hs-CRP:10.7 mg/l) and SAP (Ox-LDL:82.3 mmol/l, hs-CRP:2.10 mg/l) patients as well as controls (Ox-LDL:41.4 mmol/l, hs-CRP:1.76 mg/l). Ox-LDL/hs-CRP levels in UAP patients were significantly higher (P LDL and CRP (r = 0.622; P HDL, and LDL cholesterol did not differ among these patient groups. In conclusion, our data show that Ox-LDL and hs-CRP levels correlate positively in ACS patients, supporting the hypothesis that Ox-LDL and CRP may play a direct role in promoting the inflammatory component of atherosclerosis in these individuals. We suggest that Ox-LDL/CRP elevated levels may serve as markers of the severity of the disease in evaluation and management of ACS patients.

  14. 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...

  15. Prognosis by C-reactive protein and matrix metalloproteinase-9 levels in stable coronary heart disease during 15 years of follow-up

    DEFF Research Database (Denmark)

    Eldrup, N; Kragelund, C; Steffensen, R;

    2012-01-01

    associate with prognosis in patients with stable coronary heart disease. METHODS AND RESULTS: We measured baseline plasma CRP and matrix metalloproteinase-9 in 1090 patients with stable coronary heart disease and as the primary composite endpoint detected incident unstable angina, myocardial infarction...

  16. 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.)

  17. 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.

  18. The effect of ivabradine on long term prevention of major adverse cardiac events in acute coronary syndrome using high-sensitivity C-reactive protein level

    Directory of Open Access Journals (Sweden)

    Ahmed Fouad AbdEl Latif

    2015-08-01

    Conclusion: Administration of ivabradine within 48 h of CCU admission decreased hs-CRP level in patients with acute coronary syndrome (unstable angina but did not decrease the occurrence of major cardiac events in ACS patients.

  19. The Association of C-Reactive Protein and CRP Genotype with Coronary Heart Disease: Findings from Five Studies with 4,610 Cases amongst 18,637 Participants

    Science.gov (United States)

    Lawlor, Debbie A.; Harbord, Roger M.; Timpson, Nic J.; Lowe, Gordon D. O.; Rumley, Ann; Gaunt, Tom R.; Baker, Ian; Yarnell, John W. G.; Kivimäki, Mika; Kumari, Meena; Norman, Paul E.; Jamrozik, Konrad; Hankey, Graeme J.; Almeida, Osvaldo P.; Flicker, Leon; Warrington, Nicole; Marmot, Michael G.; Ben-Shlomo, Yoav; Palmer, Lyle J.; Day, Ian N. M.; Ebrahim, Shah; Smith, George Davey

    2008-01-01

    Background It is unclear whether C-reactive protein (CRP) is causally related to coronary heart disease (CHD). Genetic variants that are known to be associated with CRP levels can be used to provide causal inference of the effect of CRP on CHD. Our objective was to examine the association between CRP genetic variant +1444C>T (rs1130864) and CHD risk in the largest study to date of this association. Methods and Results We estimated the association of CRP genetic variant +1444C>T (rs1130864) with CRP levels and with CHD in five studies and then pooled these analyses (N = 18,637 participants amongst whom there were 4,610 cases). CRP was associated with potential confounding factors (socioeconomic position, physical activity, smoking and body mass) whereas genotype (rs1130864) was not associated with these confounders. The pooled odds ratio of CHD per doubling of circulating CRP level after adjustment for age and sex was 1.13 (95%CI: 1.06, 1.21), and after further adjustment for confounding factors it was 1.07 (95%CI: 1.02, 1.13). Genotype (rs1130864) was associated with circulating CRP; the pooled ratio of geometric means of CRP level among individuals with the TT genotype compared to those with the CT/CC genotype was 1.21 (95%CI: 1.15, 1.28) and the pooled ratio of geometric means of CRP level per additional T allele was 1.14 (95%CI: 1.11, 1.18), with no strong evidence in either analyses of between study heterogeneity (I2 = 0%, p>0.9 for both analyses). There was no association of genotype (rs1130864) with CHD: pooled odds ratio 1.01 (95%CI: 0.88, 1.16) comparing individuals with TT genotype to those with CT/CC genotype and 0.96 (95%CI: 0.90, 1.03) per additional T allele (I20.6 for both meta-analyses). An instrumental variables analysis (in which the proportion of CRP levels explained by rs1130864 was related to CHD) suggested that circulating CRP was not associated with CHD: the odds ratio for a doubling of CRP level was 1.04 (95%CI: 0.61, 1

  20. The association of C-reactive protein and CRP genotype with coronary heart disease: findings from five studies with 4,610 cases amongst 18,637 participants.

    Directory of Open Access Journals (Sweden)

    Debbie A Lawlor

    Full Text Available BACKGROUND: It is unclear whether C-reactive protein (CRP is causally related to coronary heart disease (CHD. Genetic variants that are known to be associated with CRP levels can be used to provide causal inference of the effect of CRP on CHD. Our objective was to examine the association between CRP genetic variant +1444C>T (rs1130864 and CHD risk in the largest study to date of this association. METHODS AND RESULTS: We estimated the association of CRP genetic variant +1444C>T (rs1130864 with CRP levels and with CHD in five studies and then pooled these analyses (N = 18,637 participants amongst whom there were 4,610 cases. CRP was associated with potential confounding factors (socioeconomic position, physical activity, smoking and body mass whereas genotype (rs1130864 was not associated with these confounders. The pooled odds ratio of CHD per doubling of circulating CRP level after adjustment for age and sex was 1.13 (95%CI: 1.06, 1.21, and after further adjustment for confounding factors it was 1.07 (95%CI: 1.02, 1.13. Genotype (rs1130864 was associated with circulating CRP; the pooled ratio of geometric means of CRP level among individuals with the TT genotype compared to those with the CT/CC genotype was 1.21 (95%CI: 1.15, 1.28 and the pooled ratio of geometric means of CRP level per additional T allele was 1.14 (95%CI: 1.11, 1.18, with no strong evidence in either analyses of between study heterogeneity (I(2 = 0%, p>0.9 for both analyses. There was no association of genotype (rs1130864 with CHD: pooled odds ratio 1.01 (95%CI: 0.88, 1.16 comparing individuals with TT genotype to those with CT/CC genotype and 0.96 (95%CI: 0.90, 1.03 per additional T allele (I(20.6 for both meta-analyses. An instrumental variables analysis (in which the proportion of CRP levels explained by rs1130864 was related to CHD suggested that circulating CRP was not associated with CHD: the odds ratio for a doubling of CRP level was 1.04 (95%CI: 0.61, 1.80. CONCLUSIONS

  1. The association of C-reactive protein and CRP genotype with coronary heart disease: findings from five studies with 4,610 cases amongst 18,637 participants.

    Science.gov (United States)

    Lawlor, Debbie A; Harbord, Roger M; Timpson, Nic J; Lowe, Gordon D O; Rumley, Ann; Gaunt, Tom R; Baker, Ian; Yarnell, John W G; Kivimäki, Mika; Kumari, Meena; Norman, Paul E; Jamrozik, Konrad; Hankey, Graeme J; Almeida, Osvaldo P; Flicker, Leon; Warrington, Nicole; Marmot, Michael G; Ben-Shlomo, Yoav; Palmer, Lyle J; Day, Ian N M; Ebrahim, Shah; Smith, George Davey

    2008-08-20

    It is unclear whether C-reactive protein (CRP) is causally related to coronary heart disease (CHD). Genetic variants that are known to be associated with CRP levels can be used to provide causal inference of the effect of CRP on CHD. Our objective was to examine the association between CRP genetic variant +1444C>T (rs1130864) and CHD risk in the largest study to date of this association. We estimated the association of CRP genetic variant +1444C>T (rs1130864) with CRP levels and with CHD in five studies and then pooled these analyses (N = 18,637 participants amongst whom there were 4,610 cases). CRP was associated with potential confounding factors (socioeconomic position, physical activity, smoking and body mass) whereas genotype (rs1130864) was not associated with these confounders. The pooled odds ratio of CHD per doubling of circulating CRP level after adjustment for age and sex was 1.13 (95%CI: 1.06, 1.21), and after further adjustment for confounding factors it was 1.07 (95%CI: 1.02, 1.13). Genotype (rs1130864) was associated with circulating CRP; the pooled ratio of geometric means of CRP level among individuals with the TT genotype compared to those with the CT/CC genotype was 1.21 (95%CI: 1.15, 1.28) and the pooled ratio of geometric means of CRP level per additional T allele was 1.14 (95%CI: 1.11, 1.18), with no strong evidence in either analyses of between study heterogeneity (I(2) = 0%, p>0.9 for both analyses). There was no association of genotype (rs1130864) with CHD: pooled odds ratio 1.01 (95%CI: 0.88, 1.16) comparing individuals with TT genotype to those with CT/CC genotype and 0.96 (95%CI: 0.90, 1.03) per additional T allele (I(2)0.6 for both meta-analyses). An instrumental variables analysis (in which the proportion of CRP levels explained by rs1130864 was related to CHD) suggested that circulating CRP was not associated with CHD: the odds ratio for a doubling of CRP level was 1.04 (95%CI: 0.61, 1.80). We found no association of a genetic variant

  2. Identifying coronary artery disease in men with type 2 diabetes: osteoprotegerin, pulse wave velocity, and other biomarkers of cardiovascular risk.

    LENUS (Irish Health Repository)

    Davenport, Colin

    2012-02-01

    OBJECTIVES: In patients with type 2 diabetes, high serum levels of osteoprotegerin (OPG) have been associated with a greater risk of cardiovascular events. However, it remains unclear how well OPG performs when compared with traditional biomarkers of cardiovascular risk such as high-sensitivity C-reactive protein (hsCRP). Furthermore, OPG levels are also high in the presence of diabetes-related microvascular disease, and it is unclear whether OPG can distinguish microvascular disease from large-vessel atherosclerosis. The first aim of this study was to compare OPG levels against other biomarkers of cardiovascular risk in the identification of patients with documented multivessel coronary artery disease (CAD). The second aim was to compare OPG levels in patients with microvascular complications (microalbuminuria) against those with established CAD. METHODS: Three groups of male patients with type 2 diabetes were recruited: patients without microvascular complications or large-vessel atherosclerosis (n = 24), patients with microalbuminuria only (n = 23), and patients with microalbuminuria and documented multivessel CAD (n = 25). OPG, hsCRP, interleukin 6, urate, and pulse wave velocity were measured. RESULTS: Serum OPG levels were significantly higher in patients with a combination of microalbuminuria and CAD than in those with microalbuminuria alone. There were no significant differences in any of the other biomarkers between the groups. CONCLUSION: OPG was found to be superior to the other biomarkers studied in identifying patients with documented CAD. The presence of CAD was a greater determinant of serum OPG levels than microalbuminuria in our population. These findings support the use of OPG as a biomarker of cardiovascular risk.

  3. Effects of intensive glucose control on platelet reactivity in patients with acute coronary syndromes. Results of the CHIPS Study ("Control de Hiperglucemia y Actividad Plaquetaria en Pacientes con Sindrome Coronario Agudo").

    Science.gov (United States)

    Vivas, David; García-Rubira, Juan C; Bernardo, Esther; Angiolillo, Dominick J; Martín, Patricia; Calle-Pascual, Alfonso; Núñez-Gil, Iván; Macaya, Carlos; Fernández-Ortiz, Antonio

    2011-05-01

    Hyperglycaemia has been associated with increased platelet reactivity and impaired prognosis in patients with acute coronary syndrome (ACS). Whether platelet reactivity can be reduced by lowering glucose in this setting is unknown. The aim of this study was to assess the functional impact of intensive glucose control with insulin on platelet reactivity in patients admitted with ACS and hyperglycaemia. This is a prospective, randomised trial evaluating the effects of either intensive glucose control (target glucose 80-120 mg/dl) or conventional control (target glucose 180 mg/dl or less) with insulin on platelet reactivity in patients with ACS and hyperglycaemia. The primary endpoint was platelet aggregation following stimuli with 20 μM ADP at 24 h and at hospital discharge. Aggregation following collagen, epinephrine and thrombin receptor-activated peptide, as well as P2Y₁₂ reactivity index and surface expression of glycoprotein IIb/IIIa and P-selectin were also measured. Of the 115 patients who underwent random assignment, 59 were assigned to intensive and 56 to conventional glucose control. Baseline platelet functions and inhospital management were similar in both groups. Maximal aggregation after ADP stimulation at hospital discharge was lower in the intensive group (47.9 ± 13.2% vs 59.1 ± 17.3%; p=0.002), whereas no differences were found at 24 h. Similarly all other parameters of platelet reactivity measured at hospital discharge were significantly reduced in the intensive glucose control group. In this randomised trial, early intensive glucose control with insulin in patients with ACS presenting with hyperglycaemia was found to decrease platelet reactivity. Clinical Trial Registration Number http://www.controlledtrials.com/ISRCTN35708451/ISRCTN35708451.

  4. 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.

  5. 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.

  6. High glucose-induced mitochondrial respiration and reactive oxygen species in mouse cerebral pericytes is reversed by pharmacological inhibition of mitochondrial carbonic anhydrases: Implications for cerebral microvascular disease in diabetes.

    Science.gov (United States)

    Shah, Gul N; Morofuji, Yoichi; Banks, William A; Price, Tulin O

    2013-10-18

    Hyperglycemia-induced oxidative stress leads to diabetes-associated damage to the microvasculature of the brain. Pericytes in close proximity to endothelial cells in the brain microvessels are vital to the integrity of the blood-brain barrier and are especially susceptible to oxidative stress. According to our recently published results, streptozotocin-diabetic mouse brain exhibits oxidative stress and loose pericytes by twelve weeks of diabetes, and cerebral pericytes cultured in high glucose media suffer intracellular oxidative stress and apoptosis. Oxidative stress in diabetes is hypothesized to be caused by reactive oxygen species (ROS) produced during hyperglycemia-induced enhanced oxidative metabolism of glucose (respiration). To test this hypothesis, we investigated the effect of high glucose on respiration rate and ROS production in mouse cerebral pericytes. Previously, we showed that pharmacological inhibition of mitochondrial carbonic anhydrases protects the brain from oxidative stress and pericyte loss. The high glucose-induced intracellular oxidative stress and apoptosis of pericytes in culture were also reversed by inhibition of mitochondrial carbonic anhydrases. Therefore, we extended our current study to determine the effect of these inhibitors on high glucose-induced increases in pericyte respiration and ROS. We now report that both the respiration and ROS are significantly increased in pericytes challenged with high glucose. Furthermore, inhibition of mitochondrial carbonic anhydrases significantly slowed down both the rate of respiration and ROS production. These data provide new evidence that pharmacological inhibitors of mitochondrial carbonic anhydrases, already in clinical use, may prove beneficial in protecting the brain from oxidative stress caused by ROS produced as a consequence of hyperglycemia-induced enhanced respiration. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. 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.

  8. Airway vascular reactivity and vascularisation in human chronic airway disease

    NARCIS (Netherlands)

    Bailey, Simon R; Boustany, Sarah; Burgess, Janette K; Hirst, Stuart J; Sharma, Hari S; Simcock, David E; Suravaram, Padmini R; Weckmann, Markus

    2009-01-01

    Altered bronchial vascular reactivity and remodelling including angiogenesis are documented features of asthma and other chronic inflammatory airway diseases. Expansion of the bronchial vasculature under these conditions involves both functional (vasodilation, hyperperfusion, increased microvascular

  9. Relative research between premature coronary syndromes and C-reactive protein, serum uric acid%早发冠心病中医证型与C反应蛋白、血尿酸相关性研究

    Institute of Scientific and Technical Information of China (English)

    于素甫江·苏来曼; 王娟; 张丽丽

    2014-01-01

    目的:探讨早发冠心病(premature coronary heart disease,PCHD)中医证型与C反应蛋白(CRP)及血尿酸(UA)的相关性。方法:196例经冠状动脉造影确诊为冠心病的患者(男0.05)。②血尿酸含量比较:与健康对照组相比,PCHD组血浆UA含量明显增高,差异有统计学意义(P0.05)。结论:CRP水平与PCHD中医证型存在相关性,可作为PCHD中医辨证分型辅助诊断的客观指标。%Objective:To observe the relationship between premature coronary syndromes and C-reactive protein, serum uric acid. Methods:196 patients were divided into 58 cases of Xinxue Yuzhu syndrome, 55 cases of Tanzhuo Bizu syndrome, 83 cases of Feitan yu syndrome. 57 patients were selected as control group. Results: ①CRP content was higher with stastical difference in PCHD group (P0.05); ②Blood UA content was obviously higher in PCHD group with stastical difference (P0.05). Conclusion:There is a relationship between premature coronary syndromes and C-reactive protein, serum uric acid and can be used as a index for TCM differentiation.

  10. 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...

  11. Impairment of Coronary Arteriolar Endothelium-Dependent Dilation after Multi-Walled Carbon Nanotube Inhalation: A Time-Course Study

    Directory of Open Access Journals (Sweden)

    Timothy R. Nurkiewicz

    2012-10-01

    Full Text Available Engineered nanomaterials have been developed for widespread applications due to many highly unique and desirable characteristics. The purpose of this study was to assess pulmonary inflammation and subepicardial arteriolar reactivity in response to multi-walled carbon nanotube (MWCNT inhalation and evaluate the time course of vascular alterations. Rats were exposed to MWCNT aerosols producing pulmonary deposition. Pulmonary inflammation via bronchoalveolar lavage and MWCNT translocation from the lungs to systemic organs was evident 24 h post-inhalation. Coronary arterioles were evaluated 24–168 h post-exposure to determine microvascular response to changes in transmural pressure, endothelium-dependent and -independent reactivity. Myogenic responsiveness, vascular smooth muscle reactivity to nitric oxide, and α-adrenergic responses all remained intact. However, a severe impact on endothelium-dependent dilation was observed within 24 h after MWCNT inhalation, a condition which improved, but did not fully return to control after 168 h. In conclusion, results indicate that MWCNT inhalation not only leads to pulmonary inflammation and cytotoxicity at low lung burdens, but also a low level of particle translocation to systemic organs. MWCNT inhalation also leads to impairments of endothelium-dependent dilation in the coronary microcirculation within 24 h, a condition which does not fully dissipate within 168 h. The innovations within the field of nanotechnology, while exciting and novel, can only reach their full potential if toxicity is first properly assessed.

  12. 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...

  13. High sensitive C-reactive protein, adiponectin, and urine albumin excretion rate in Chinese coronary artery disease patients with different glucose tolerance status

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Background Serum high sensitive C-reactive protein (hs-CRP), adiponectin levels and urine albumin excretion rate (UAER) are probably associated with inflammation and atherosclerosis. The aim of this study was to determine the three markers in coronary artery disease (CAD) subjects with different glucose tolerance status in a Chinese population and further explore the levels of the three markers in these subjects and the possible association of these markers with CAD risk factors and the severity of CAD as well. Methods A total of 242 subjects with angiographically documented CAD were recruited, and then assigned to three groups: the normal glucose tolerance (NGT) + CAD group, including 100 CAD patients with NGT; the impaired glucose tolerance (IGT) + CAD group, 40 CAD patients with IGT; the type 2 diabetes mellitus (T2DM) + CAD group, 102 CAD patients with T2DM. Serum hs-CRP, adiponectin levels as well as UAER were measured in all subjects. Results Serum hs-CRP levels were increased in the T2DM + CAD group compared with the NGT + CAD group (4.71±2.59) vs (3.60±2.46) mg/L, P=0.037. Serum adiponectin levels were gradually decreased from the NGT + CAD to IGT + CAD to T2DM + CAD groups, (5.99±1.84), (5.82±1.72) and (4.65±1.71) mg/L, P=0.002 and 0.040 for NGT + CAD and IGT + CAD groups vs T2DM + CAD group, respectively. While the UAER was gradually increased from the NGT + CAD to IGT + CAD to T2DM + CAD groups, (6.42±2.51), (6.89±2.94) and (15.03±4.22) pg/min (P<0.001) for NGT + CAD and IGT + CAD groups vs T2DM + CAD group. Multiple linear stepwise regression analysis showed that waist-hip ratio (WHR) and low density lipoprotein cholesterol (LDL-C) were the significant determinants of serum hs-CRP levels; triglyceride (TG), high density lipoprotein cholesterol (HDL-C), age, WHR, T2DM, 2-hour serum insulin (2hlNS), sex, and apolipoprotein B were the significant determinants of serum adiponecUn levels; and systolic blood pressure (SBP), T2DM, and hemoglobin Alc

  14. 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.

  15. Impact of Hemoglobin A1c Levels on Residual Platelet Reactivity and Outcomes After Insertion of Coronary Drug-Eluting Stents (from the ADAPT-DES Study)

    DEFF Research Database (Denmark)

    Schoos, Mikkel M.; Dangas, George D.; Mehran, Roxana

    2016-01-01

    and aspirin reaction units >550, respectively. HPR on clopidogrel was frequent (48.3%), whereas HPR on aspirin was not (3.9%). Patients with HbA1c >8.5% were younger, more likely non-Caucasian, had a greater body mass index, and more insulin-treated diabetes and acute coronary syndromes. Proportions of PRU...

  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. 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. 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...

  19. 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.

  20. 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

  1. Relationship between different subpopulations of circulating CD4+ T lymphocytes and microvascular or systemic oxidative stress in humans.

    Science.gov (United States)

    De Ciuceis, Carolina; Agabiti-Rosei, Claudia; Rossini, Claudia; Airò, Paolo; Scarsi, Mirko; Tincani, Angela; Tiberio, Guido Alberto Massimo; Piantoni, Silvia; Porteri, Enzo; Solaini, Leonardo; Duse, Sarah; Semeraro, Francesco; Petroboni, Beatrice; Mori, Luigi; Castellano, Maurizio; Gavazzi, Alice; Agabiti-Rosei, Enrico; Rizzoni, Damiano

    2017-08-01

    Different components of the immune system, including innate and adaptive immunity (T effector lymphocytes and T regulatory lymphocytes - TREGs) may be involved in the development of hypertension, vascular injury and inflammation. However, no data are presently available in humans about possible relationships between T-lymphocyte subtypes and microvascular oxidative stress. Our objective was to investigate possible relationships between T-lymphocyte subtypes and systemic and microvascular oxidative stress in a population of normotensive subjects and hypertensive patients. In the present study we enrolled 24 normotensive subjects and 12 hypertensive patients undergoing an elective surgical intervention. No sign of local or systemic inflammation was present. All patients underwent a biopsy of subcutaneous fat during surgery. A peripheral blood sample was obtained before surgery for assessment of T lymphocyte subpopulations by flow cytometry and circulating indices of oxidative stress. A significant direct correlation was observed between Th1 lymphocytes and reactive oxygen species (ROS) production (mainly in microvessels). Additionally, significant inverse correlations were observed between ROS and total TREGs, or TREGs subtypes. Significant correlations were detected between circulating indices of oxidative stress/inflammation and indices of microvascular morphology/Th1 and Th17 lymphocytes. In addition, a significant inverse correlation was detected between TREGs in subcutaneous small vessels and C reactive protein. Our data suggest that TREG lymphocytes may be protective against microvascular damage, probably because of their anti-oxidant properties, while Th1-Th17 lymphocytes seem to exert an opposite effect, confirming an involvement of adaptive immune system in microvascular damage.

  2. Evaluating the quality of research into a single prognostic biomarker: a systematic review and meta-analysis of 83 studies of C-reactive protein in stable coronary artery disease.

    Directory of Open Access Journals (Sweden)

    Harry Hemingway

    2010-06-01

    Full Text Available BACKGROUND: Systematic evaluations of the quality of research on a single prognostic biomarker are rare. We sought to evaluate the quality of prognostic research evidence for the association of C-reactive protein (CRP with fatal and nonfatal events among patients with stable coronary disease. METHODS AND FINDINGS: We searched MEDLINE (1966 to 2009 and EMBASE (1980 to 2009 and selected prospective studies of patients with stable coronary disease, reporting a relative risk for the association of CRP with death and nonfatal cardiovascular events. We included 83 studies, reporting 61,684 patients and 6,485 outcome events. No study reported a prespecified statistical analysis protocol; only two studies reported the time elapsed (in months or years between initial presentation of symptomatic coronary disease and inclusion in the study. Studies reported a median of seven items (of 17 from the REMARK reporting guidelines, with no evidence of change over time. The pooled relative risk for the top versus bottom third of CRP distribution was 1.97 (95% confidence interval [CI] 1.78-2.17, with substantial heterogeneity (I(2 = 79.5. Only 13 studies adjusted for conventional risk factors (age, sex, smoking, obesity, diabetes, and low-density lipoprotein [LDL] cholesterol and these had a relative risk of 1.65 (95% CI 1.39-1.96, I(2 = 33.7. Studies reported ten different ways of comparing CRP values, with weaker relative risks for those based on continuous measures. Adjusting for publication bias (for which there was strong evidence, Egger's p<0.001 using a validated method reduced the relative risk to 1.19 (95% CI 1.13-1.25. Only two studies reported a measure of discrimination (c-statistic. In 20 studies the detection rate for subsequent events could be calculated and was 31% for a 10% false positive rate, and the calculated pooled c-statistic was 0.61 (0.57-0.66. CONCLUSION: Multiple types of reporting bias, and publication bias, make the magnitude of any

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

    Science.gov (United States)

    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.

  4. 5-HT1D receptor agonists and human coronary artery reactivity in vitro: crossover comparisons of 5-HT and sumatriptan with rizatriptan and L-741,519.

    Science.gov (United States)

    Longmore, J; Boulanger, C M; Desta, B; Hill, R G; Schofield, W N; Taylor, A A

    1996-10-01

    1. Rizatriptan (MK-462, (N,N-dimethyl-2-[5-(1,2,4-triazol-1-ylmethyl)-1H-indol-3-yl] ethylamine)) and its structurally related analogue L-741,519 (N-methyl-4-[5-(1,2,4-triazol-4-yl)-1H-indol-3-yl]piperidine) are novel 5-HT1D-receptor agonists. Rizatriptan has shown efficacy as an anti-migraine agent in clinical trials. Since angiographic studies in patients have shown that sumatriptan (an established 5-HT1D-receptor agonist) can cause coronary artery vasoconstriction, we compared the effects of rizatriptan and L-741,519 with those of 5-HT and sumatriptan on endothelium-denuded segments of human coronary artery in vitro. 2. Coronary arteries were obtained from explanted hearts from patients undergoing cardiac transplantation (n = 16 viable arteries from 13 males, 3 females, aged 38-68 years) and arterial segments (5-6 mm in length) were mounted in organ baths for isometric tension recording. Each segment was first exposed to 45mM KCl and then to 5-HT (1 nM-100 microM). Concentration-effect curves to rizatriptan and sumatriptan (Study 1, n = 6 or 7 arteries) or sumatriptan and L-741,519 (Study 2, n = 8 arteries) were then performed in a consecutive and random manner. The response to repeated application of 5-HT was obtained in separate segments. 3. One artery showed severe atheroma and was not included in the analysis. ANOVA showed that 5-HT responsiveness varied significantly between arteries from different patients; but not between arterial segments from the same patient. Desensitization was seen consistently across all agonists but did not significantly affect inter-agonist comparisons. 4. There was graded effectiveness in the ability of the agonists to cause contraction with the rank order of Emax values being 5-HT > sumatriptan > L-741,519 > rizatriptan. In terms of EC50 values, L-741,519 was significantly more potent than sumatriptan. 5. The present study (using a 'cross-over' experimental protocol) confirms our previous observation that rizatriptan is less

  5. Prevalência de alta reatividade plaquetária em pacientes tratados com aspirina encaminhados para angiografia coronária Prevalence of high platelet reactivity in aspirin-treated patients referred for coronary angiography

    Directory of Open Access Journals (Sweden)

    André Manica

    2013-01-01

    Full Text Available FUNDAMENTO: A aspirina (Ácido Acetilsalicílico - AAS é capaz de reduzir eventos adversos cardiovasculares em pacientes portadores de Doença Arterial Coronariana (DAC através da inibição da atividade plaquetária. Alguns pacientes com DAC, apesar da terapia com AAS, apresentam Alta Reatividade Plaquetária (ARP, o que determina um maior risco para o desenvolvimento de eventos cardiovasculares. OBJETIVO: O objetivo deste estudo foi determinar a prevalência de ARP em pacientes tratados com AAS e encaminhados para cinecoronariografia, além de avaliar se existe uma possível correlação entre a gravidade da DAC e o desenvolvimento de ARP. MÉTODOS: Estudo de centro único onde foram incluídos 115 pacientes consecutivos, tratados com AAS e portadores de DAC estável. A reatividade plaquetária induzida pelo ADP e colágeno foram avaliadas através da Agregometria de Transmitância Luminosa (ATL. Pacientes com agregação plaquetária maior que 70%, induzida por ambos os reagentes, foram classificados como tendo ARP e, neste grupo, a adesão ao tratamento com AAS foi avaliada através da dosagem dos níveis séricos de salicilato. RESULTADOS: A média de idade foi de 60,9 anos e a dose média de AAS foi de 164,2 mg. Tabagismo e diabetes melito estavam presentes em 28,7% e 31,5% dos pacientes, respectivamente. Foi encontrada ARP em 14 pacientes (13%, entretanto, em sete indivíduos (50% com ARP observaram-se baixos níveis séricos de salicilato (BACKGROUND: Aspirin (ASA reduces adverse events in coronary artery disease (CAD patients by inhibiting platelets. Some CAD patients have high platelet reactivity (HPR despite ASA therapy and these individuals have increased risk of adverse events. OBJECTIVE: The purpose of this study was to determine the prevalence of HPR in ASA-treated patients referred for coronary angiography and to assess whether the HPR correlates with the severity of CAD. METHODS: This single center investigation enrolled 115

  6. Prevalência de alta reatividade plaquetária em pacientes tratados com aspirina encaminhados para angiografia coronária Prevalence of high platelet reactivity in aspirin-treated patients referred for coronary angiography

    Directory of Open Access Journals (Sweden)

    André Manica

    2013-01-01

    Full Text Available FUNDAMENTO: A aspirina (Ácido Acetilsalicílico - AAS é capaz de reduzir eventos adversos cardiovasculares em pacientes portadores de Doença Arterial Coronariana (DAC através da inibição da atividade plaquetária. Alguns pacientes com DAC, apesar da terapia com AAS, apresentam Alta Reatividade Plaquetária (ARP, o que determina um maior risco para o desenvolvimento de eventos cardiovasculares. OBJETIVO: O objetivo deste estudo foi determinar a prevalência de ARP em pacientes tratados com AAS e encaminhados para cinecoronariografia, além de avaliar se existe uma possível correlação entre a gravidade da DAC e o desenvolvimento de ARP. MÉTODOS: Estudo de centro único onde foram incluídos 115 pacientes consecutivos, tratados com AAS e portadores de DAC estável. A reatividade plaquetária induzida pelo ADP e colágeno foram avaliadas através da Agregometria de Transmitância Luminosa (ATL. Pacientes com agregação plaquetária maior que 70%, induzida por ambos os reagentes, foram classificados como tendo ARP e, neste grupo, a adesão ao tratamento com AAS foi avaliada através da dosagem dos níveis séricos de salicilato. RESULTADOS: A média de idade foi de 60,9 anos e a dose média de AAS foi de 164,2 mg. Tabagismo e diabetes melito estavam presentes em 28,7% e 31,5% dos pacientes, respectivamente. Foi encontrada ARP em 14 pacientes (13%, entretanto, em sete indivíduos (50% com ARP observaram-se baixos níveis séricos de salicilato (BACKGROUND: Aspirin (ASA reduces adverse events in coronary artery disease (CAD patients by inhibiting platelets. Some CAD patients have high platelet reactivity (HPR despite ASA therapy and these individuals have increased risk of adverse events. OBJECTIVE: The purpose of this study was to determine the prevalence of HPR in ASA-treated patients referred for coronary angiography and to assess whether the HPR correlates with the severity of CAD. METHODS: This single center investigation enrolled 115

  7. Head to Head Comparison of Two Point-of-care Platelet Function Tests Used for Assessment of On-clopidogrel Platelet Reactivity in Chinese Acute Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention

    Institute of Scientific and Technical Information of China (English)

    Yi Yao; Jia-Hui Zhang; Xiao-Fang Tang; Chen He; Yuan-Liang Ma; Jing-Jing Xu; Ying Song

    2016-01-01

    Background:Platelet function tests are widely used in clinical practice to guide personalized antiplatelet therapy.In China,the thromboelastography (TEG) test has been well accepted in clinics,whereas VerifyNow,mainly used for scientific research,has not been used in routine clinical practice.The aim of the current study was to compare these two point-of-care platelet function tests and to analyze the consistency between the two tests for evaluating on-clopidogrel platelet reactivity in Chinese acute myocardial infarction patients undergoing percutaneous coronary intervention (PCI).Methods:A total of 184 patients admitted to Fuwai Hospital between August 2014 and May 2015 were enrolled in the study.On-clopidogrel platelet reactivity was assessed 3 days after PCI by TEG and VerifyNow using adenosine diphosphate as an agonist.Based on the previous reports,an inhibition of platelet aggregation (IPA) <30% for TEG or a P2Y12 reaction unit (PRU) >230 for VerifyNow was defined as high on-clopidogrel platelet reactivity (HPR).An IPA >70% or a PRU <178 was defined as low on-clopidogrel platelet reactivity (LPR).Correlation and agreement between the two methods were analyzed using the Spearman correlation coefficient (r) and kappa value (κ),respectively.Results:Our results showed that VerifyNow and TEG had a moderate but significant correlation in evaluating platelet reactivity (r =-0.511).A significant although poor agreement (κ =0.225) in identifying HPR and a significantly moderate agreement in identifying LPR (κ =0.412) were observed between TEG and VerifyNow.By using TEG as the reference for comparison,the cutoffvalues of VerifyNow for the Chinese patients in this study were identified as PRU >205 for HPR and PRU <169 for LPR.Conclusions:By comparing VerifyNow to TEG which has been widely used in clinics,VerifyNow could be an attractive alternative to TEG for monitoring on-clopidogrel platelet reactivity in Chinese patients.

  8. 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.

  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. Comparison of usefulness of C-reactive protein versus white blood cell count to predict outcome after primary percutaneous coronary intervention for ST elevation myocardial infarction

    NARCIS (Netherlands)

    Smit, Jaap Jan J.; Ottervanger, Jan Paul; Slingerland, Robbert J.; Kolkman, J. J. Evelien; Suryapranata, Harry; Hoorntje, Jan C. A.; Dambrink, Jan-Henk E.; Gosselink, A. T. Marcel; de Boer, Menko-Jan; Zijlstra, Felix; van 't Hof, Arnoud W. J.

    2008-01-01

    White blood cell (WBC) count and high-sensitive C-reactive protein (hs-CRP) are both used as markers of inflammation and prognosis after an ST elevation myocardial infarction (STEMI), but it is unknown whether they have independent prognostic value. We investigated the association and independent pr

  12. 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

  13. Genetic variations of the endothelial nitric oxide synthase gene are related to increased levels of C-reactive protein and macrophage-colony stimulating-factor in patients with coronary artery disease.

    Science.gov (United States)

    Lekakis, John P; Ikonomidis, Ignatios; Tsibida, Maria; Protogerou, Athanasios; Papada, Aggeliki; Papapanagiotou, Aggeliki; Revela, Ioanna; Papamichael, Christos M; Kalofoutis, Anastasios T; Kremastinos, Dimitrios T

    2006-10-01

    It was the objective of this study to investigate the relation between nitric oxide synthase (NOS3) gene polymorphisms, vascular inflammation, endothelial function, and atherosclerosis. We examined the effects of a variable nucleotide tandem repeats (VNTR) in intron 4, G894T in exon 7 and T-786C at the promoter region of NOS3 on i) C-reactive protein (CRP) and macrophage-colony stimulating-factor (MCSF), and ii) augmentation index (AI) measured by pulse-wave analysis , flow-mediated dilation (FMD) of the brachial artery, intima-media thickness (IMT) of the carotid and femoral artery using ultrasonography and ankle-brachial index (ABI) in 122 patients with chronic coronary artery disease (CAD) who underwent coronary angiography. MCSF and CRP were increased in patients withT-786C (77/122) or VNTR (40/122) allele compared to those without (F = 10.8, p = 0.002 and F = 3.8, p = 0.04 for T-786C and F = 3.65, p = 0.04 and F = 3.2 p = 0.049 forVNTR), even after adjustment for traditional risk factors and medication. Patients with combination of VNTR and T-786C (31/122) had higher MCSF or CRP than patients with one or none of these alleles (p 262 pg/ml or CRP>3.2 mg/l (n = 33/77) had a higher femoral and carotid IMT and number of plaques in the peripheral arteries than those with lower values of these inflammatory indices (p 262 pg/ml had also lower FMD and higher Gensini score than those with lower MCSF (p < 0.05). The intron 4-VNTR and T-786C mutation of NOS3 gene enhance the inflammatory process in patients with chronic CAD.

  14. 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.

  15. 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

  16. 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

  17. 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.

  18. 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

  19. Effects of lercanidipine on coronary reactivity and myocardial remodeling in transition to heart failure in cardiomyopathic hamsters%Lercanidipine对心肌病仓鼠心力衰竭过程中冠状反应和重构的作用

    Institute of Scientific and Technical Information of China (English)

    Julie MASSICOTTE; Antoine VIENS; Ming-Hui YAO; Amedeo LEONARDI; Giorgio SIRONI; Hongbo WANG; Louis DUMONT

    2003-01-01

    AIM: Lercanidipine is a new vasoselective dihydropyridine calcium channel blocker with a short plasma half-life,long duration of action, and demonstrated cardioprotective properties. We hypothesized that it might be effective atattenuating the adverse impact observed on the coronary compartment and myocardium in the transition phase toheart failure in the UM-X7.1 cardiomyopathic (CM) hamster. METHODS: The effects of 4-month exposure tolercanidipine 3 and 10 mg/kg (daily oral administration) were evaluated in 150-day-old CM hamsters and in age-matched normal hamsters. Coronary reactivity (reactive hyperemia to 30-s coronary occlusion) and the responseto the administration of acetylcholine (100 nmol/L) and sodium nitroprusside (1 μmol/L) were assessed monthly,using the isolated perfused heart model. The left ventricular chamber dilatation index and wall thickness, myocar-dial fibrosis and myocardial capillary density (papillary muscle) were estimated in selected subgroups at monthlyintervals. RESULTS: High-dose lercanidipine had beneficial effects on coronary dysfunctions: at month 4 of thetreatment period, reactive hyperemia to short duration ischemia was improved, as was the endothelium-dependentvasodilator response (acetylcholine=68 %± 16 % vs 11%±5 % in untreated CM hamsters, P<0.05)and endothe-lium-independent vasodilator response (sodium nitroprusside=36 %±5% vs 22 %± 12 % in untreated CM hamsters,P<0.05). Capillary density averaged 10 879±474 capillaries per mm2in papillary muscle from normal hamsters; thisvalue did not change over time in normal hamsters and was not affected during the transition phase to heart failurein CM hamsters. Lercanidipine preserved myocardial capillary density in these conditions. Chronic exposure tolercanidipine had no impact on myocardial remodeling observed in CM hamsters. CONCLUSION: Lercanidipinehad a beneficial impact on the coronary compartment in the transition phase to heart failure in a model of

  20. Association of low educational status with microvascular complications in type 2 diabetes: Jaipur diabetes registry

    Directory of Open Access Journals (Sweden)

    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.

  1. 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.

  2. Zebrafish as a Model for the Study of Microvascular Complications of Diabetes and Their Mechanisms

    Directory of Open Access Journals (Sweden)

    Karl Heckler

    2017-09-01

    Full Text Available Diabetes mellitus (DM is a crucial metabolic disease that leads to severe disorders. These include macrovascular complications such as myocardial infarction, stroke, and peripheral artery disease and microvascular complications including diabetic nephropathy, neuropathy, and retinopathy. Diabetes mellitus, along with its associated organ pathologies, is one of the key problems in today’s medicine. Zebrafish is an upcoming disease model organism in diabetes research. Its glucose metabolism and the pathways of reactive metabolite formation are very similar to those of humans. Moreover, several physiological and pathophysiological pathways that also exist in humans and other mammals have been identified in this species or are currently under intense investigation. Zebrafish offer sophisticated imaging techniques and allow simple and fast genetic and pharmacological approaches with a high throughput. In this review, we highlight achievements and mechanisms concerning microvascular complications discovered in zebrafish, and we discuss the advantages and disadvantages of zebrafish as a model for studying diabetic complications.

  3. 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.

  4. Clinical perspective on C-reactive protein in prognostication of major adverse cardiac events in the elderly with established coronary heart disease

    Institute of Scientific and Technical Information of China (English)

    Olabode Oladeinde

    2006-01-01

    @@ The systemic response to tissue injury, regardless of cause is characterized by a cytokine-mediated alteration in the hepatic synthesis of a number of different plasma proteins,known collectively as 'acute phase reactants'. These proteins include C-reactive protein, serum amyloid A protein, alphal glycoprotein, ceruloplasmin, alpha macroglobulins, complement components (C1-C4, factor B, C9, C11), alpha1antitrypsin, alpha1 antichymotrypsin, fibrinogen, prothrombin,factor Ⅷ, plasminogen, haptoglobin, ferritin, immunoglobulins and lipoproteins. The initiation of the acute phase response is linked to the production of hormone-like polypeptide mediators now called cytokines, namedly, interleukin 1(IL-1),tumor necrosis factor, interferon gamma, interleukin 6 (IL-6),leukemia inhibitory factor, ciliary neurotropic factor, oncostatin M, and interleukin 11 (IL- 11).

  5. 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.

  6. 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.

  7. 冠状动脉介入术后患者血小板高反应性的影响因素分析%Influential Factors Analysis on High Platelet Reactivity of Patients Undergoing Coronary Artery Stenting

    Institute of Scientific and Technical Information of China (English)

    许盛松; 郭玲玉; 张明亮; 周璇; 张俊峰

    2016-01-01

    Objective To investigate the incidence and influential factors of high on treatment platelet reactivity in patients undergoing dual antiplatelet therapy after percutaneous coronary intervention (PCI) .Methods There were 334 patients with coronary heart disease (CHD) receiving PCI in the Cardiology Department of our hospital .All patients had been given 100mg aspirin and 75mg clopidogrel per day for at least 48hours after the interventional treatment .Thrombelastograph (TEG) was used to record on treatment platelet re-activity .Defining 30% of the platelet inhibition rate induced by adenosine diphosphate (ADP) as the critical value ,this research di-vided patients into a high on clopidogrel treatment platelet reactivity (HPR) group (inhibition rate 30 .00% ) .The baseline data ,laboratory examination results ,and clinical data were com-pared between HPR and NPR .Logistic regression was applied to analyze the influential factors of HPR as well .Results The incidence of HPR in 334 CHD patients after PCI was 44 .90% .In univariate analysis of HPR ,there were statistically significant differences in AA inhibition rate ,serum creatinine level ,gender ,chronic kidney disease (CKD) ,and smoking history between HPR and NPR groups (P < 0 .05) .A conditional Logistic regression analysis showed that high levels of AA inhibition rate (OR :0 .98 ,95% CI :0 . 97 ~ 0 .99 ,P< 0 .01) and high levels of serum creatinine (OR = 0 .98 ,95% CI :0 .97 ~ 0 .99 , P< 0 .01) were probably indepen-dent influential factors of HPR .Conclusions High levels of AA inhibition rate and High levels of serum creatinine were probably inde-pendent protective factors of HPR .%目的:探讨经皮冠状动脉介入术(percutaneous coronary intervention ,PCI)后双联抗血小板治疗的冠心病患者血小板高反应性及其影响因素。方法选取在本院心内科住院并行 PCI 术的冠心病患者334例,术后接受100mg 阿司匹林和75mg 氯吡格雷治疗至少48小时,于晨

  8. Comparison of loading with maintenance dose of clopidogrel on platelet reactivity in Chinese with different CYP2C19 genotypes prior to percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    Zhang Xiaoxing; Yan Lirong; Wang Dongxue; Li Yan; Han Lulu; Tian Lei; Liu Hong

    2014-01-01

    Background Whether two clopidogrel pretreatment strategies prior to elective percutaneous coronary intervention (PCI):a 300 mg loading dose (LD) in clopidogrel naive patients and a 75 mg maintenance dose (MD) once daily in patients on chronic clopidogrel therapy play the same role in the platelet inhibition in Chinese with different CYP2C19 genotypes remains unknown.We aim to evaluate the impact on platelet inhibition by clopidogrel pretreatment strategy and its interaction effect with CYP2C19 genotype.Methods Chinese patients undergoing PCI (n=840) were assigned to 2x2 groups in the trial according to different clopidogrel pretreatment strategies (470 patients in LD,370 patients in MD) and CYP2C19 genotypes (494 carriers of any CYP2C19 *2 or *3 loss-of-function allele,346 non-carriers).The primary outcome was platelet aggregation (PA) as measured by the 10 μmol/L adenosine diphosphate induced light transmission aggregation.Results Compared with MD group,LD strategy showed a significantly higher PA-((59.22±11.67)% vs.(52.83±12.17)%,P <0.01),similar PA difference was observed in CYP2C19 loss-of-function carriers compared with non-carriers ((59.41±10.91)% vs.(52.10±12.90)%,P <0.01).LD patients in either the CYP2C19 loss-of-function allele carrier or noncarrier group showed a significantly higher PA compared with MD group ((61.50±10.61)% vs.(56.84±10.74)%,P <0.01;(56.06±12.34)% vs.(46.88±11.78)%,P <0.01,respectively).A quantitative interaction effect was observed between clopidogrel pretreatment strategy and CYP2C19 genotype (P=0.001).Conclusion The 300 mg LD strategy results in a decreased effect on platelet inhibition compared with the 75 mg MD in Chinese patients receiving clopidogrel prior to PCI,especially in the CYP2C19 *2 or *3 loss-of-function allele non-carriers.(ClinicalTrials.gov number NCT01710436)

  9. Cerium dioxide nanoparticle exposure improves microvascular dysfunction and reduces oxidative stress in spontaneously hypertensive rats

    Directory of Open Access Journals (Sweden)

    Valerie C Minarchick

    2015-11-01

    Full Text Available The elevated production of reactive oxygen species (ROS in the vascular wall is associated with cardiovascular diseases such as hypertension. This increase in oxidative stress contributes to various mechanisms of vascular dysfunction, such as decreased nitric oxide bioavailability. Therefore, anti-oxidants are being researched to decrease the high levels of ROS, which could improve the microvascular dysfunction associated with various cardiovascular diseases. From a therapeutic perspective, cerium dioxide nanoparticles (CeO2 NP hold great anti-oxidant potential, but their in vivo activity is unclear. Due to this potential anti-oxidant action, we hypothesize that injected CeO2 NP would decrease microvascular dysfunction and oxidative stress associated with hypertension. In order to simulate a therapeutic application, spontaneously hypertensive (SH and Wistar-Kyoto (WKY rats were intravenously injected with either saline or CeO2 NP (100 µg suspended in saline. Twenty-four hours post-exposure mesenteric arteriolar reactivity was assessed via intravital microscopy. Endothelium-dependent and –independent function was assessed via acetylcholine and sodium nitroprusside. Microvascular oxidative stress was analyzed using fluorescent staining in isolated mesenteric arterioles. Finally, systemic inflammation was examined using a multiplex analysis and venular leukocyte flux was counted. Endothelium-dependent dilation was significantly decreased in the SH rats (29.68 ± 3.28%, maximal response and this microvascular dysfunction was significantly improved following CeO2 NP exposure (43.76 ± 4.33%, maximal response. There was also an increase in oxidative stress in the SH rats, which was abolished following CeO2 NP treatment. These results provided evidence that CeO2 NP act as an anti-oxidant in vivo. There were also changes in the inflammatory profile in the WKY and SH rats. In WKY rats, IL-10 and TNF-α were increased following CeO2 NP treatment

  10. 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.

  11. 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.

  12. 血清高敏C反应蛋白与急性冠脉综合征临床相关性研究%Serum High Sensitive C - reactive Protein in Acute Coronary Syndrome

    Institute of Scientific and Technical Information of China (English)

    陈召起; 王永霞; 胡宇才; 朱明军; 高传玉

    2009-01-01

    Ohjective To study the serum high sensitive C - reactive protein (hs -CRP) in patients (pts) with acute coronary syn-drome. Methods One hundred pts with CHD,were divided into acute coronary syndrome(ACS) group(n=62),stable angina pectoris (SAP) group(n = 38),and healthy controls(NCHD)group(n = 30). The levels of serum hs -CRP were measured with enzyme - linked immunosorbent ashy. Results The level of serum hs- CRP was significantly higher in the ACS group titan that in NCHD group(P<0.01). There was significantly difference in the level of serum hs - CRP between the ACS group and SAP group(P<0.05). Conclusion Serum hs-CRP was one of the indexes for the inflammation of atherosclerosis, which was an important serum maker of the attack and serve degree of ACS.%目的 探讨血清高敏C反应蛋白(hs-CRP)指标的变化与急性冠脉综合征(ACS)发病之间的关系,以期发现这种变化与急性冠脉综合征发病的预测意义.方法 选取河南省人民医院心内科2007年9月-2007年12月入院诊断为冠心病且入院后行冠脉造影术的患者100例为研究对象,急性冠脉综合征组(ACS组)62例,稳定型心绞痛组(SAP组)38例;另选取健康体检者30名为对照组(NCHD组).以双抗体夹心酶联免疫吸附法(ELLSA)检测血清hs-CRP.结果 ACS组患者血清hs-CRP水平明显高于健康对照组(P<0.01);ACS组与SAP组血清hs-CRP水平比较,差异亦有统计学意义(P<0.05).结论 hs-CRP可作为急性冠脉综合征发病及判断其严重程度的重要血清标志物.

  13. 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 ...

  14. Soluble CD40L in children and adolescents with type 1 diabetes: relation to microvascular complications and glycemic control.

    Science.gov (United States)

    El-Asrar, Mohamed A; Adly, Amira Am; Ismail, Eman A

    2012-12-01

    CD40-soluble CD40 ligand (sCD40L) interactions might constitute an important mediator for vascular inflammation that initiates diabetic microangiopathy. Little is known about the relation between sCD40L and glycemic control. Therefore, this study aimed to evaluate sCD40L levels in patients with type 1 diabetes and its relation to microvascular complications and metabolic control. Sixty patients with type 1 diabetes were compared with 30 healthy control subjects. Detailed medical history, thorough clinical examination, and laboratory assessment of high-sensitivity C-reactive protein, glycemic control, and the presence of microvascular complications were performed. Measurement of serum sCD40L levels was done using enzyme-linked immunosorbent assay. Patients were divided into two groups according to the presence of microvascular complications. Serum sCD40L levels were significantly elevated in patients with type 1 diabetes in both groups compared with healthy controls (p < 0.001). Patients with microvascular complications had higher serum sCD40L concentrations than non-complicated cases (median, 13 000 vs. 450 pg/mL; p < 0.001). Serum sCD40L cutoff value of 530 pg/mL was able to differentiate complicated from non-complicated cases (p < 0.001). Patients with microalbuminuria or peripheral neuropathy showed higher levels of sCD40L when compared with patients without these complications (p < 0.05). Serum sCD40L levels were positively correlated with hemoglobin A1c and urinary albumin excretion (p < 0.001). We suggest that serum sCD40L levels are elevated in type 1 diabetes, particularly in patients with microvascular complications and a significant correlation with glycemic control exists. Therefore, measurement of serum sCD40L levels in poorly controlled patients would help to identify those at high risk of developing microvascular complications.

  15. 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

  16. Mesenteric microvascular inflammatory responses to systemic hypoxia are mediated by PAF and LTB4.

    Science.gov (United States)

    Casillan, Alfred J; Gonzalez, Norberto C; Johnson, Jennifer S; Steiner, Dawn R S; Wood, John G

    2003-06-01

    Systemic hypoxia produces a rapid microvascular inflammatory response characterized by increased reactive oxygen species (ROS) levels, leukocyte-endothelial adherence and emigration, and increased vascular permeability. The lipid inflammatory mediator leukotriene B(4) (LTB(4)) is involved in the early hypoxia-induced responses (ROS generation and leukocyte adherence). Whether other lipid inflammatory mediators participate in this phenomenon is not known. The objective of these experiments was to study the role of platelet-activating factor (PAF) in the microvascular inflammatory response to hypoxia and its potential interactions with LTB(4) in this response. Intravital microscopy was used to examine mesenteric venules of anesthetized rats. We found that WEB-2086, a PAF receptor antagonist, completely prevented the increase in ROS levels and leukocyte adherence during a brief reduction in inspired Po(2) to anesthetized rats; administration of either WEB-2086 or the LTB(4) antagonist LTB(4)-DMA attenuated leukocyte emigration and the increase in vascular permeability to the same extent during prolonged systemic hypoxia in conscious rats. Furthermore, no additive effect was observed in either response when both antagonists were administered simultaneously. This study demonstrates a role for PAF in the rapid microvascular inflammatory response to hypoxia, as well as contributions of PAF and LTB(4) to the slowly developing responses observed during sustained hypoxia. The incomplete blockade of the hypoxia-induced increases in vascular permeability and leukocyte emigration by combined administration of both antagonists indicates that factors in addition to LTB(4) and PAF participate in these phenomena.

  17. Evaluation of Adenosine Triphosphate-Binding Cassette Transporter A1 (ABCA1) R219K and C-Reactive Protein Gene (CRP) +1059G/C Gene Polymorphisms in Susceptibility to Coronary Heart Disease.

    Science.gov (United States)

    Li, Jing-Fang; Peng, Dian-Ying; Ling, Mei; Yin, Yong

    2016-08-25

    BACKGROUND This meta-analysis investigated the correlation of ABCA1 R219K and C-Reactive Protein Gene (CRP) +1059G/C gene polymorphisms with susceptibility to coronary heart disease (CHD). MATERIAL AND METHODS We searched PubMed, Springer link, Wiley, EBSCO, Ovid, Wanfang database, VIP database, and China National Knowledge Infrastructure (CNKI) databases to retrieve published studies by keyword. Searches were filtered using our stringent inclusion and exclusion criteria. Resultant high-quality data collected from the final selected studies were analyzed using Comprehensive Meta-analysis 2.0 software. Eleven case-control studies involving 3053 CHD patients and 3403 healthy controls met our inclusion criteria. Seven studies were conducted in Asian populations, 3 studies were done in Caucasian populations, and 1 was in an African population. RESULTS Our major finding was that ABCA1 R219K polymorphism increased susceptibility to CHD in allele model (OR=0.729, 95% CI=0.559~0.949, P=0.019) and dominant model (OR=0.698, 95% CI=0.507~0.961, P=0.027). By contrast, we were unable to find any significant association between the CRP +1059G/C polymorphism and susceptibility to CHD (allele model: OR=1.170, 95% CI=0.782~1.751, P=0.444; dominant model: OR=1.175, 95% CI=0.768~1.797, P=0.457). CONCLUSIONS This meta-analysis provides convincing evidence that polymorphism of ABCA1 R219K is associated with susceptibility to CHD while the CRP +1059G/C polymorphism appears to have no correlation with susceptibility to CHD.

  18. High prevalence of C-reactive protein elevation with normal triglycerides (100-149 mg/dL): are triglyceride levels below 100 mg/dL more optimal in coronary heart disease risk assessment?

    Science.gov (United States)

    Ahmad, Irfan; Zhan, Min; Miller, Michael

    2005-04-01

    The National Cholesterol Education Program defines a fasting triglyceride level below 150 mg/dL as normal. However, observational data suggest that triglyceride levels above 100 mg/dL may predict coronary heart disease (CHD) events. To determine the prevalence of systemic inflammation with a normal triglyceride level (100-149 mg/dL), data obtained from the population-based cross-sectional study of 4412 men and women in the third National Health and Nutrition Examination Survey were reviewed. Measurements included fasting lipids and lipoproteins and serum C-reactive protein (CRP) level measured using a Behring Nephelometer Analyzer System. High CRP level was equally prevalent whether the designated triglyceride cutpoint was greater than or equal to 100 (unadjusted OR, 2.0; 95% CI, 1.7-2.3) or greater than or equal to 150 (unadjusted OR, 1.9; 95% CI, 1.6-2.2). After adjustment for other covariates, the triglyceride range of 100 to 149 mg/dL remained independently associated with elevated CRP level (OR, 1.3; 95% CI, 1.02-1.67). In addition, an approximately fivefold higher likelihood of elevated CRP level was observed with triglyceride levels between 100 and 149 mg/dL and normal body mass index (BMI; 24-24.9) compared with lower triglyceride level (triglyceride levels (100-150 mg/dL) are associated with systemic inflammation and that lower fasting triglyceride levels (eg, <100 rather than <150 mg/dL) may be a more optimal cutpoint in CHD risk assessment.

  19. 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

  20. Induction of complement proteins in a mouse model for cerebral microvascular Aβ deposition

    Directory of Open Access Journals (Sweden)

    DeFilippis Kelly

    2007-09-01

    Full Text Available Abstract The deposition of amyloid β-protein (Aβ in cerebral vasculature, known as cerebral amyloid angiopathy (CAA, is a common pathological feature of Alzheimer's disease and related disorders. In familial forms of CAA single mutations in the Aβ peptide have been linked to the increase of vascular Aβ deposits accompanied by a strong localized activation of glial cells and elevated expression of neuroinflammatory mediators including complement proteins. We have developed human amyloid-β precursor protein transgenic mice harboring two CAA Aβ mutations (Dutch E693Q and Iowa D694N that mimic the prevalent cerebral microvascular Aβ deposition observed in those patients, and the Swedish mutations (K670N/M671L to increase Aβ production. In these Tg-SwDI mice, we have reported predominant fibrillar Aβ along microvessels in the thalamic region and diffuse plaques in cortical region. Concurrently, activated microglia and reactive astrocytes have been detected primarily in association with fibrillar cerebral microvascular Aβ in this model. Here we show that three native complement components in classical and alternative complement pathways, C1q, C3, and C4, are elevated in Tg-SwDI mice in regions rich in fibrillar microvascular Aβ. Immunohistochemical staining of all three proteins was increased in thalamus, hippocampus, and subiculum, but not frontal cortex. Western blot analysis showed significant increases of all three proteins in the thalamic region (with hippocampus as well as the cortical region, except C3 that was below detection level in cortex. Also, in the thalamic region (with hippocampus, C1q and C3 mRNAs were significantly up-regulated. These complement proteins appeared to be expressed largely by activated microglial cells associated with the fibrillar microvascular Aβ deposits. Our findings demonstrate that Tg-SwDI mice exhibit elevated complement protein expression in response to fibrillar vascular Aβ deposition that is

  1. Induction of complement proteins in a mouse model for cerebral microvascular A beta deposition.

    Science.gov (United States)

    Fan, Rong; DeFilippis, Kelly; Van Nostrand, William E

    2007-09-18

    The deposition of amyloid beta-protein (A beta) in cerebral vasculature, known as cerebral amyloid angiopathy (CAA), is a common pathological feature of Alzheimer's disease and related disorders. In familial forms of CAA single mutations in the A beta peptide have been linked to the increase of vascular A beta deposits accompanied by a strong localized activation of glial cells and elevated expression of neuroinflammatory mediators including complement proteins. We have developed human amyloid-beta precursor protein transgenic mice harboring two CAA A beta mutations (Dutch E693Q and Iowa D694N) that mimic the prevalent cerebral microvascular A beta deposition observed in those patients, and the Swedish mutations (K670N/M671L) to increase A beta production. In these Tg-SwDI mice, we have reported predominant fibrillar A beta along microvessels in the thalamic region and diffuse plaques in cortical region. Concurrently, activated microglia and reactive astrocytes have been detected primarily in association with fibrillar cerebral microvascular A beta in this model. Here we show that three native complement components in classical and alternative complement pathways, C1q, C3, and C4, are elevated in Tg-SwDI mice in regions rich in fibrillar microvascular A beta. Immunohistochemical staining of all three proteins was increased in thalamus, hippocampus, and subiculum, but not frontal cortex. Western blot analysis showed significant increases of all three proteins in the thalamic region (with hippocampus) as well as the cortical region, except C3 that was below detection level in cortex. Also, in the thalamic region (with hippocampus), C1q and C3 mRNAs were significantly up-regulated. These complement proteins appeared to be expressed largely by activated microglial cells associated with the fibrillar microvascular A beta deposits. Our findings demonstrate that Tg-SwDI mice exhibit elevated complement protein expression in response to fibrillar vascular A beta deposition

  2. 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.

  3. 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.

  4. Strategies for Primary Prevention of Coronary Heart Disease Based on Risk Stratification by the ACC/AHA Lipid Guidelines, ATP III Guidelines, Coronary Calcium Scoring, and C-Reactive Protein, and a Global Treat-All Strategy: A Comparative--Effectiveness Modeling Study.

    Directory of Open Access Journals (Sweden)

    Benjamin Z Galper

    Full Text Available Several approaches have been proposed for risk-stratification and primary prevention of coronary heart disease (CHD, but their comparative and cost-effectiveness is unknown.We constructed a state-transition microsimulation model to compare multiple approaches to the primary prevention of CHD in a simulated cohort of men aged 45-75 and women 55-75. Risk-stratification strategies included the 2013 American College of Cardiology/American Heart Association (ACC/AHA guidelines on the treatment of blood cholesterol, the Adult Treatment Panel (ATP III guidelines, and approaches based on coronary artery calcium (CAC scoring and C-reactive protein (CRP. Additionally we assessed a treat-all strategy in which all individuals were prescribed either moderate-dose or high-dose statins and all males received low-dose aspirin. Outcome measures included CHD events, costs, medication-related side effects, radiation-attributable cancers, and quality-adjusted-life-years (QALYs over a 30-year timeframe.Treat-all with high-dose statins dominated all other strategies for both men and women, gaining 15.7 million QALYs, preventing 7.3 million myocardial infarctions, and saving over $238 billion, compared to the status quo, far outweighing its associated adverse events including bleeding, hepatitis, myopathy, and new-onset diabetes. ACC/AHA guidelines were more cost-effective than ATP III guidelines for both men and women despite placing 8.7 million more people on statins. For women at low CHD risk, treat-all with high-dose statins was more likely to cause a statin-related adverse event than to prevent a CHD event.Despite leading to a greater proportion of the population placed on statin therapy, the ACC/AHA guidelines are more cost-effective than ATP III. Even so, at generic prices, treating all men and women with statins and all men with low-dose aspirin appears to be more cost-effective than all risk-stratification approaches for the primary prevention of CHD

  5. Strategies for Primary Prevention of Coronary Heart Disease Based on Risk Stratification by the ACC/AHA Lipid Guidelines, ATP III Guidelines, Coronary Calcium Scoring, and C-Reactive Protein, and a Global Treat-All Strategy: A Comparative--Effectiveness Modeling Study

    Science.gov (United States)

    Galper, Benjamin Z.; Wang, Y. Claire; Einstein, Andrew J.

    2015-01-01

    Background Several approaches have been proposed for risk-stratification and primary prevention of coronary heart disease (CHD), but their comparative and cost-effectiveness is unknown. Methods We constructed a state-transition microsimulation model to compare multiple approaches to the primary prevention of CHD in a simulated cohort of men aged 45–75 and women 55–75. Risk-stratification strategies included the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on the treatment of blood cholesterol, the Adult Treatment Panel (ATP) III guidelines, and approaches based on coronary artery calcium (CAC) scoring and C-reactive protein (CRP). Additionally we assessed a treat-all strategy in which all individuals were prescribed either moderate-dose or high-dose statins and all males received low-dose aspirin. Outcome measures included CHD events, costs, medication-related side effects, radiation-attributable cancers, and quality-adjusted-life-years (QALYs) over a 30-year timeframe. Results Treat-all with high-dose statins dominated all other strategies for both men and women, gaining 15.7 million QALYs, preventing 7.3 million myocardial infarctions, and saving over $238 billion, compared to the status quo, far outweighing its associated adverse events including bleeding, hepatitis, myopathy, and new-onset diabetes. ACC/AHA guidelines were more cost-effective than ATP III guidelines for both men and women despite placing 8.7 million more people on statins. For women at low CHD risk, treat-all with high-dose statins was more likely to cause a statin-related adverse event than to prevent a CHD event. Conclusions Despite leading to a greater proportion of the population placed on statin therapy, the ACC/AHA guidelines are more cost-effective than ATP III. Even so, at generic prices, treating all men and women with statins and all men with low-dose aspirin appears to be more cost-effective than all risk-stratification approaches for the

  6. 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.

  7. Coronary risk stratification : from PREVEND to the prevention of coronary events

    NARCIS (Netherlands)

    Geluk, Christiane Anneliese

    2008-01-01

    The aim of the thesis was to evaluate some of the unresolved issues on the pathway from risk association to risk stratification with regard to C-reactive protein, urinary albumin excretion and coronary calcium. This thesis shows that C-reactive protein is associated to angiographic evidence of

  8. 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.

  9. 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

  10. 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.

  11. NT-proBNP levels, atherosclerosis and vascular function in asymptomatic type 2 diabetic patients with microalbuminuria: peripheral reactive hyperaemia index but not NT-proBNP is an independent predictor of coronary atherosclerosis

    DEFF Research Database (Denmark)

    Reinhard, Henrik; Wiinberg, Niels; Hansen, Peter R

    2011-01-01

    for atherosclerosis is unclear. We examined the interrelationship between P-NT-proBNP, presence of atherosclerosis and/or vascular dysfunction in the coronary, carotid and peripheral arteries in asymptomatic type 2 diabetic patients with microalbuminuria that received intensive multifactorial treatment. METHODS...... AND RESULTS: P-NT-proBNP was measured in 200 asymptomatic type 2 patients without known cardiac disease that received intensive multifactorial treatment for CV risk reduction. Patients were examined for coronary, carotid and peripheral atherosclerosis, as defined by coronary calcium score=400, carotid intima...

  12. NT-proBNP levels, atherosclerosis and vascular function in asymptomatic type 2 diabetic patients with microalbuminuria: peripheral reactive hyperaemia index but not NT-proBNP is an independent predictor of coronary atherosclerosis

    DEFF Research Database (Denmark)

    Reinhard, Henrik; Wiinberg, Niels; Hansen, Peter R

    2011-01-01

    for atherosclerosis is unclear. We examined the interrelationship between P-NT-proBNP, presence of atherosclerosis and/or vascular dysfunction in the coronary, carotid and peripheral arteries in asymptomatic type 2 diabetic patients with microalbuminuria that received intensive multifactorial treatment. METHODS...... AND RESULTS: P-NT-proBNP was measured in 200 asymptomatic type 2 patients without known cardiac disease that received intensive multifactorial treatment for CV risk reduction. Patients were examined for coronary, carotid and peripheral atherosclerosis, as defined by coronary calcium score≥400, carotid intima...

  13. 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

  14. 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

  15. 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

  16. High residual platelet reactivity during dual antiplatelet therapy, found by optical aggregometry and the rate of atherothrombotic complications after coronary artery stenting in patients with ischemic heart disease in clinical practice

    Directory of Open Access Journals (Sweden)

    N. F. Puchinyan

    2016-01-01

    Full Text Available Aim. To study the prevalence of high residual platelet reactivity (HRPR during the dual antiplatelet therapy (DAT with acetylsalicylic acid (ASA and clopidogrel by optical aggregometry in patients with ischemic heart disease (IHD after percutaneous transluminal coronary angioplasty (PTCA in clinical practice, as well as to determine its value for the prediction of clinical course and outcome of disease.Material and methods. Patients after PTCA and during DAT were included into the study. Evaluation of the functional activity of platelets by optical aggregometry was performed in all patients at baseline. Resistance to ASA, clopidogrel and DAT were detected. Endpoints included cases of repeated atherothrombotic events (sudden cardiac death, myocardial infarction, unstable angina, ischemic stroke, stent thrombosis. Adherence to therapy was evaluated by Morisky-Green test.Results. 97 patients were included into the final analysis. The risk of myocardial infarction or unstable angina pectoris in the ASA-resistant patients was significantly higher than this in the DAT-sensitive patients [relative risk (RR=7.68; 95% confidence interval (CI 2.8-20.54; p=0.045]. Maximum RR for stent thrombosis was in clopidogrel-resistant (RR=7.1; 95% CI 1.41-35.82; p=0.0485 and DAT-resistant patients (RR=12.8; 95% CI 4.5-36.38; p=0.0491, compared with patients with a sensitivity to antiplatelet therapy. DAT-resistance was associated with a higher RR of the combined endpoint, compared with the sensitivity to antiplatelet therapy (RR=10.24; 95% CI 3.96-26.5; p=0.046], and have a tendency to association with increased risk of combined endpoint compared with isolated ASA-resistance (RR=1.3; 95% CI 0.68-2.6; p=0.081.Conclusion. HRPR during DAT is common in clinical practice in patients with ischemic heart disease after PTCA. Routine use of optical aggregometry in DAT may help to identify patients with an increased risk of thrombotic events in the postoperative period and to

  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. 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.

  20. 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.

  1. 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...

  2. 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)

  3. 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.

  4. 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.

  5. 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

  6. 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.

  7. 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.

  8. 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.

  9. Relationship between the severity of heart failure and hypersensitive C-reactive protein in patients with coronary heart disease%冠心病患者心力衰竭严重程度与超敏C反应蛋白水平的关系

    Institute of Scientific and Technical Information of China (English)

    李海滨

    2016-01-01

    Objective To study the relationship between the severity of heart failure and hypersensitive c-reactive protein, and to provide guidance for clinical treatment strategies for coronary heart disease with heart failure. Methods 150 clearly di-agnosed coronary heart disease with heart failure patients were selected in the experimental group, and 150 coronary heart dis-ease without heart failure patients were control group. Then, the experimental group were classification by the severity of heart failure and detected the level of the hypersensitive c-reactive protein. The relationship between heart failure and hs-CRP were evaluated and compared with the control group. Results Compared with control group, hypersensitive c-reactive protein in CHD patients with heart failure were significantly decreased, and a negative correlation between the degree of heart failure and hs-CRP levels was founded. Conclusion The heart failure severity of coronary heart disease patients is closely related to the levels of hs-CRP.%目的:研究冠心病患者心力衰竭严重程度与超敏 C 反应蛋白水平的关系,为临床治疗冠心病伴心力衰竭提供指导策略。方法:随机选择我院的冠心病伴心力衰竭的患者150例为实验组,冠心病不伴有心力衰竭的患者150例为对照组,然后给实验组患者的心衰程度进行分级并测定实验组患者的超敏 C 反应蛋白的含量,观察二者是否存在关系,并与对照组进行对比。结果:与心功能正常相比,心衰患者的超敏 C 反应蛋白明显降低,且患者的心衰程度与超敏 C 反应蛋白水平呈负相关。结论:冠心病患者心力衰竭严重程度与超敏 C 反应蛋白水平密切相关。

  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. 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.

  13. 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.

  14. Concomitant macro and microvascular complications in diabetic nephropathy

    Directory of Open Access Journals (Sweden)

    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

  15. Propionyl-L-Carnitine Enhances Wound Healing and Counteracts Microvascular Endothelial Cell Dysfunction.

    Directory of Open Access Journals (Sweden)

    Maria Giovanna Scioli

    Full Text Available Impaired wound healing represents a high cost for health care systems. Endothelial dysfunction characterizes dermal microangiopathy and contributes to delayed wound healing and chronic ulcers. Endothelial dysfunction impairs cutaneous microvascular blood flow by inducing an imbalance between vasorelaxation and vasoconstriction as a consequence of reduced nitric oxide (NO production and the increase of oxidative stress and inflammation. Propionyl-L-carnitine (PLC is a natural derivative of carnitine that has been reported to ameliorate post-ischemic blood flow recovery.We investigated the effects of PLC in rat skin flap and cutaneous wound healing. A daily oral PLC treatment improved skin flap viability and associated with reactive oxygen species (ROS reduction, inducible nitric oxide synthase (iNOS and NO up-regulation, accelerated wound healing and increased capillary density, likely favoring dermal angiogenesis by up-regulation for iNOS, vascular endothelial growth factor (VEGF, placental growth factor (PlGF and reduction of NADPH-oxidase 4 (Nox4 expression. In serum-deprived human dermal microvascular endothelial cell cultures, PLC ameliorated endothelial dysfunction by increasing iNOS, PlGF, VEGF receptors 1 and 2 expression and NO level. In addition, PLC counteracted serum deprivation-induced impairment of mitochondrial β-oxidation, Nox4 and cellular adhesion molecule (CAM expression, ROS generation and leukocyte adhesion. Moreover, dermal microvascular endothelial cell dysfunction was prevented by Nox4 inhibition. Interestingly, inhibition of β-oxidation counteracted the beneficial effects of PLC on oxidative stress and endothelial dysfunction.PLC treatment improved rat skin flap viability, accelerated wound healing and dermal angiogenesis. The beneficial effects of PLC likely derived from improvement of mitochondrial β-oxidation and reduction of Nox4-mediated oxidative stress and endothelial dysfunction. Antioxidant therapy and

  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. Study the relationship between adiponectin and coronary heart disease

    Institute of Scientific and Technical Information of China (English)

    Xue-Hui Yang; Li-Xin Zhao; Yan-Hong Lu; Xiao-Jun Li; Jun Shi

    2015-01-01

    Objective: To study whether adiponectin in serum of patients with coronary heart disease is reduced, and compare with the test results in total cholesterol (TC), Triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), blood glucose (GLU), C-reactive protein (CRP). Method: We selected 80 cases of coronary heart disease patients as the experimental group, 50 healthy subjects as control group. The coronary heart disease group compared with the control group, we know the changes of adiponectin in coronary heart disease group and compared coronary heart disease group with control group in test results of blood lipid, blood glucose, C-reactive protein. Results: Adiponectin in coronary heart disease group was (0.47±0.09) mg/L, which decreased significantly comparing to control group’s level (t=-18.4, P<0.001), HDL-C in coronary heart disease group was (1.24±0.04) mmol/L, which decreased significantly comparing to control group’s level (t=-27.67, P<0.001). The difference was statistically significant (P<0.05). Conclusion: The level’s adiponectin in patients of coronary heart disease dropped, which lead to hypoadiponectinemia, Hypoadiponectinemia may be one of the risk factors of coronary heart disease.

  18. 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.

  19. [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.

  20. Plasma concentrations of ascorbic acid and C-reactive protein, and risk of future coronary artery disease, in apparently healthy men and women: the EPIC-Norfolk prospective population study

    NARCIS (Netherlands)

    S.M. Boekholdt; M.C. Meuwese; N.E. Day; R. Luben; A. Welch; N.J. Wareham; K.T. Khaw

    2006-01-01

    High plasma concentrations of ascorbic acid, a marker of fruit and vegetable intake, are associated with low risk of coronary artery disease. Whether this relationship is explained by a reduction in systemic inflammation is unclear. We investigated the relationship between ascorbic acid plasma conce

  1. 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.

  2. 冠心病患者血清同型半胱氨酸、超敏C反应蛋白、脂蛋白(a)及D-二聚体联合检测的意义%Application of homocysteine, serum high sensitive C-reactive protein, lipoprotein A and D-two dimer combined detection in the course of coronary heart disease

    Institute of Scientific and Technical Information of China (English)

    齐振勇; 葛俊丽; 齐振水

    2013-01-01

    Objective To study the meaning of Homocysteine,serum high sensitive C-reactive protein,lipoprotein A and D-two dimer combined detection in the course of coronary heart disease.Methods Select 180 cases suffering from different types of coronary heart disease as group of coronary heart disease,200 healthy people who were in our hospital physical examination qualified over the same period as the control group,all the cases of fasting venous blood was sampled respectively to detect the content of Hcy,hs-CRP,LP(a) and DD.Results Coronary heart disease group of patients with Hcy,hs-CRP,LP(a) and DD levels were significantly higher than those of the control group of healthy persons(t =13.87,10.24,9.86,18.02,P < 0.05),Comparison among different indicators of the patiens with Coronary heart disease:the group of AMI was higher than the group of UAP (t =15.79,9.73,11.47,17.34,all P < 0.05),the group of UAP was higher than the group of SAP (t =16.82,8.14,10.65,18.27,P <0.05),the group of SAP was higher than the group of SMI (t =14.36,10.35,9.98,16.52,P < 0.05).Conclusion Monitoring of Hcy,hs-CRP,LP(a) and DD for coronary heart disease,contributes to the understand of the development of the course of coronary heart disease and assess the risk of coronary heart disease.%目的 探讨同型半胱氨酸(Hcy)、超敏C-反应蛋白(hs-CRP)、脂蛋白(a)[LP(a)]和D-二聚体(DD)联合检测在冠心病诊疗中的应用价值.方法 对180例冠心病患者(冠心病组)和同期来该院体检合格的健康人200例(对照组)分别检测Hcy、hs-CRP、LP(a)和DD水平,比较两组各项检测指标的差异.结果 冠心病组Hcy、hs-CRP、LP(a)和DD含量均明显高于对照组(t=13.87、10.24、9.86、18.02,均P<0.05).冠心病患者各组间各项指标比较:AMI组明显高于UAP组(t=15.79、9.73、11.47、17.34,均P<0.05)、UAP组明显高于SAP组(t=16.82、8.14、10.65、18.27,均P<0.05)、SAP组明显高于SMI组(t=14.36、10.35、9.98、16.52,均P<0

  3. Non-Invasive Measurement of Skin Microvascular Response during Pharmacological and Physiological Provocations.

    Directory of Open Access Journals (Sweden)

    Fredrik Iredahl

    Full Text Available Microvascular changes in the skin due to pharmacological and physiological provocations can be used as a marker for vascular function. While laser Doppler flowmetry (LDF has been used extensively for measurement of skin microvascular responses, Laser Speckle Contrast Imaging (LSCI and Tissue Viability Imaging (TiVi are novel imaging techniques. TiVi measures red blood cell concentration, while LDF and LSCI measure perfusion. Therefore, the aim of this study was to compare responses to provocations in the skin using these different techniques.Changes in skin microcirculation were measured in healthy subjects during (1 iontophoresis of sodium nitroprusside (SNP and noradrenaline (NA, (2 local heating and (3 post-occlusive reactive hyperemia (PORH using LDF, LSCI and TiVi.Iontophoresis of SNP increased perfusion (LSCI: baseline 40.9±6.2 PU; 10-min 100±25 PU; p<0.001 and RBC concentration (TiVi: baseline 119±18; 10-min 150±41 AU; p = 0.011. No change in perfusion (LSCI was observed after iontophoresis of NA (baseline 38.0±4.4 PU; 10-min 38.9±5.0 PU; p = 0.64, while RBC concentration decreased (TiVi: baseline 59.6±11.8 AU; 10-min 54.4±13.3 AU; p = 0.021. Local heating increased perfusion (LDF: baseline 8.8±3.6 PU; max 112±55 PU; p<0.001, LSCI: baseline 50.8±8.0 PU; max 151±22 PU; p<0.001 and RBC concentration (TiVi: baseline 49.2±32.9 AU; max 99.3±28.3 AU; p<0.001. After 5 minutes of forearm occlusion with prior exsanguination, a decrease was seen in perfusion (LDF: p = 0.027; LSCI: p<0.001 and in RBC concentration (p = 0.045. Only LSCI showed a significant decrease in perfusion after 5 minutes of occlusion without prior exsanguination (p<0.001. Coefficients of variation were lower for LSCI and TiVi compared to LDF for most responses.LSCI is more sensitive than TiVi for measuring microvascular changes during SNP-induced vasodilatation and forearm occlusion. TiVi is more sensitive to noradrenaline-induced vasoconstriction. LSCI and Ti

  4. 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.

  5. Correlation Factor Analysis of Retinal Microvascular Changes in Patients With Essential Hypertension

    Institute of Scientific and Technical Information of China (English)

    Huang Duru; Huang Zhongning

    2006-01-01

    Objectives To investigate correlation between retinal microvascular signs and essential hypertension classification. Methods The retinal microvascular signs in patients with essential hypertension were assessed with the indirect biomicroscopy lens, the direct and the indirect ophthalmoscopes were used to determine the hypertensive retinopathy grades and retinal arteriosclerosis grades.The rank correlation analysis was used to analysis the correlation these grades with the risk factors concerned with hypertension. Results Of 72 cases with essential hypertension, 28 cases complicated with coronary disease, 20 cases diabetes, 41 cases stroke,17 cases renal malfunction. Varying extent retinal arterioscleroses were found in 71 cases, 1 case with retinal hemorrhage, 2 cases with retina edema, 4 cases with retinal hard exudation, 5 cases with retinal hemorrhage complicated by hard exudation, 2 cases with retinal hemorrhage complicated by hard exudation and cotton wool spot, 1 case with retinal hemorrhage complicated by hard exudation and microaneurysms,1 case with retinal edema and hard exudation, 1 case with retinal microaneurysms, 1 case with branch retinal vein occlusion. The rank correlation analysis showed that either hypertensive retinopathy grades or retinal arteriosclerosis grades were correlated with risk factor lamination of hypertension (r=0.25 or 0.31, P<0.05), other correlation factors included age and blood high density lipoprotein concerned about hypertensive retinopathy grades or retinal arteriosclerosis grades, but other parameters, namely systolic or diastolic pressure, total cholesterol, triglyceride, low density lipoprotein cholesterol, fasting blood glucose,blood urea nitrogen and blood creatinine were not confirmed in this correlation analysis (P > 0.05).Conclusions Either hypertensive retinopathy grade or retinal arteriosclerosis grade is close with the hypertension risk factor lamination, suggesting that the fundus examination of patients with

  6. A Novel Microvascular Flow Technique: Initial Results in Thyroids.

    Science.gov (United States)

    Machado, Priscilla; Segal, Sharon; Lyshchik, Andrej; Forsberg, Flemming

    2016-03-01

    To evaluate the flow imaging capabilities of a new prototype ultrasound (US) image processing technique (superb micro-vascular imaging [SMI]; Toshiba Medical Systems, Tokyo, Japan) for depiction of microvascular flow in normal thyroid tissue and thyroid nodules compared with standard color and power Doppler US imaging.Ten healthy volunteers and 22 patients, with a total of 25 thyroid nodules, scheduled for US-guided fine needle aspiration were enrolled in this prospective study. Subjects underwent US examination consisting of grayscale, color and power Doppler imaging (CDI and PDI) followed by color and monochrome SMI and pulsed Doppler. SMI is a novel, microvascular flow imaging mode implemented on the Aplio 500 US system (Toshiba). SMI uses advanced clutter suppression to extract flow signals from large to small vessels and depicts this information at high frame rates as a color overlay image or as a monochrome map of flow. Two radiologists independently scored still images and digital clips for overall flow detection, vessel branching details and noise on a visual-analog scale of 1 (worst) to 10 (best).For the volunteers SMI visualized microvasculature with significantly lower velocity than CDI and PDI (P SMI demonstrated microvascular flow with significantly higher image scores and provided better depiction of the vessel branching details compared with CDI and PDI (P SMI mode than in the other modes, including color SMI (P SMI mode consistently improved the depiction of thyroid microvascular flow compared with standard CDI and PDI.

  7. Diabetic Peripheral Microvascular Complications: Relationship to Cognitive Function

    Directory of Open Access Journals (Sweden)

    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.

  8. ‘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...

  9. 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.

  10. Effects of coronary stenting on blood levels of C-reactive protein and troponin T%冠状动脉支架置入术对冠心病患者C反应蛋白及肌钙蛋白T的影响

    Institute of Scientific and Technical Information of China (English)

    刘海波; 高润霖; 陈纪林; 杨跃进; 秦学文; 乔树宾; 姚民; 吴永健; 宋杰; 陈在嘉

    2001-01-01

    Objective C-reactive protein (CRP) is a sensitive indicator of inflammation, and recent studies have showed that CRP is a risk factor for a poor outcome of coronary angioplasty. The aim of the study was to examine the effect of coronary stenting on blood levels of CRP and evaluate the association between blood CRP and troponin T (TnT). Methods Sixty-four patients who underwent coronary stenting from January to April, 1999, were included in this study, and 28 patients who received coronary angiography during the same period were selectecd as controls. Blood samples for measurement of CRP and TnT were taken in the early morning of the procedure and the followed early morning after the procedure. Results In patients with coronary stenting, CRP levels after the procedure were significantly higher than that before the procedure (P=0.01), but blood levels of TnT after the procedure were not significantly higher than that before the procedure (P=0.32). In patients with angiography, bot hCRP and TnT levels after angiography were not significantly higher than those before angiography (P>0.05). Conclusion Coronary stenting causes a detectable increase in blood levels of C-reactive protein. The increase might not be secondary to myocardial injury, but simply reflect the intrinsic inflammation or tissue damage within the arterial lesions treated with stenting.%目的评价经皮冠状动脉支架置入术(CS)对血液C反应蛋白(CRP)及肌钙蛋白T(TnT)的影响,并探讨CRP与TnT的关系。方法选择1999年1月至4月在我院行CS的患者为研究对象(n=64),同时选择一组同期进行冠状动脉造影(CAG)的患者作为对照(n=28)。分别于CS或CAG术当天及术后第二天清晨采集空腹血进行血液CRP及TnT水平的测定。结果 CS组患者术后血清CRP水平显著高于术前(P=0.01);TnT水平与术前比较差别无显著性(P=0.32)。CAG组患者,造影后血液CRP及TnT水平与造影前比较差别均无显著性(P>0.05)。

  11. Profile of Microvascular Disease in Type 2 Diabetes in a Tertiary ...

    African Journals Online (AJOL)

    Morbidity and mortality in patients with type 2 diabetes mellitus. (T2DM) is attributed to the microvascular and macrovascular ... the clinical profile of microvascular diabetes complications [peripheral sensory neuropathy ..... District, south India.

  12. 探讨同型半胱氨酸联合超敏 C-反应蛋白和血脂类项目检测在冠心病中的临床价值%Investigation of clinical value of homocysteine combined with high-sensitive C-reactive protein and blood lipid index detection in coronary heart disease

    Institute of Scientific and Technical Information of China (English)

    邓世忠

    2015-01-01

    Objective To investigate the clinical value of homocysteine (HCY) combined with high-sensitive C-reactive protein (hs-CRP) and blood lipid index detection in coronary heart disease. Methods There were 90 coronary heart disease patients as observation group, and another 90 healthy people as control group. Detected data of HCY, hs-CRP, and normal blood lipid indexes were summarized in the two groups, and their data were comparatively analyzed. Results The control group had all higher detected values of HCY, hs-CRP, and normal blood lipid indexes than the observation group, and their difference had statistical significance (P<0.05). Conclusion Detection of HCY, hs-CRP, and normal blood lipid index contains important significance and value in clinical treatment of coronary heart disease.%目的:探讨同型半胱氨酸(HCY)联合超敏 C-反应蛋白(hs-CRP)和血脂类项目检测在冠心病中的临床价值。方法90例冠心病患者设为观察组,90例健康体检者设为对照组。对两组的 HCY、hs-CRP 和常见血脂类检测数据进行统计,并对各项数据进行对比分析。结果对照组的 HCY、hs-CRP 和常见血脂类测量值均优于观察组的测量值,两组比较差异具有统计学意义(P<0.05)。结论HCY、hs-CRP 和血脂类项目的检测在冠心病临床治疗中具有重要的意义和价值。

  13. Influence of acute renal failure on coronary vasoregulation in dogs.

    Science.gov (United States)

    Kingma, John G; Vincent, Chantal; Rouleau, Jacques R; Kingma, Iris

    2006-05-01

    Impaired renal function is associated with an increased risk for cardiovascular events and death, but the pathophysiology is poorly defined. The hypothesis that coronary blood flow regulation and distribution of ventricular blood flow could be compromised during acute renal failure (ARF) was tested. In two separate groups (n = 14 each) of dogs with ARF, (1) coronary autoregulation (pressure-flow relations), vascular reserve (reactive hyperemia), and myocardial blood flow distribution (microspheres) and (2) coronary vessel responses to intracoronary infusion of select endothelium-dependent and -independent vasodilators were evaluated. In addition, coronary pressure-flow relations and vascular reserve after inhibition of nitric oxide and prostaglandin release were evaluated. Under resting conditions, myocardial oxygen consumption increased in dogs with ARF compared with no renal failure (NRF; 11.8 +/- 9.2 versus 5.0 +/- 1.5 ml O(2)/min per 100 g; P = 0.01), and the autoregulatory break point of the coronary pressure-flow relation was shifted to higher diastolic coronary pressures (60 +/- 17 versus 52 +/- 8 mmHg in NRF; P = 0.003); the latter was shifted further rightward after inhibition of both nitric oxide and prostaglandin release. The endocardial/epicardial blood flow ratio was comparable for both groups, suggesting preserved ventricular distribution of blood flow. In dogs with ARF, coronary vascular conductance also was reduced (P = 0.001 versus NRF), but coronary zero-flow pressure was unchanged. Vessel reactivity to each endothelium-dependent/independent compound also was blunted significantly. In conclusion, under resting conditions, coronary vascular tone, reserve, and vessel reactivity are markedly diminished with ARF, suggesting impaired vascular function. Consequently, during ARF, small increases in myocardial oxygen demand would induce subendocardial ischemia as a result of a limited capacity to increase oxygen supply and thereby contribute to higher

  14. Active cooling of microvascular composites for battery packaging

    Science.gov (United States)

    Pety, Stephen J.; Chia, Patrick X. L.; Carrington, Stephen M.; White, Scott R.

    2017-10-01

    Batteries in electric vehicles (EVs) require a packaging system that provides both thermal regulation and crash protection. A novel packaging scheme is presented that uses active cooling of microvascular carbon fiber reinforced composites to accomplish this multifunctional objective. Microvascular carbon fiber/epoxy composite panels were fabricated and their cooling performance assessed over a range of thermal loads and experimental conditions. Tests were performed for different values of coolant flow rate, channel spacing, panel thermal conductivity, and applied heat flux. More efficient cooling occurs when the coolant flow rate is increased, channel spacing is reduced, and thermal conductivity of the host composite is increased. Computational fluid dynamics (CFD) simulations were also performed and correlate well with the experimental data. CFD simulations of a typical EV battery pack confirm that microvascular composite panels can adequately cool battery cells generating 500 W m‑2 heat flux below 40 °C.

  15. Influence of anatomical dominance and hypertension on coronary conduit arterial and microcirculatory flow patterns: a multiscale modeling study.

    Science.gov (United States)

    Mynard, Jonathan P; Smolich, Joseph J

    2016-07-01

    Coronary hemodynamics are known to be affected by intravascular and extravascular factors that vary regionally and transmurally between the perfusion territories of left and right coronary arteries. However, despite clinical evidence that left coronary arterial dominance portends greater cardiovascular risk, relatively little is known about the effects of left or right dominance on regional conduit arterial and microcirculatory blood flow patterns, particularly in the presence of systemic or pulmonary hypertension. We addressed this issue using a multiscale numerical model of the human coronary circulation situated in a closed-loop cardiovascular model. The coronary model represented left or right dominant anatomies and accounted for transmural and regional differences in vascular properties and extravascular compression. Regional coronary flow dynamics of the two anatomical variants were compared under normotensive conditions, raised systemic or pulmonary pressures with maintained flow demand, and after accounting for adaptations known to occur in acute and chronic hypertensive states. Key findings were that 1) right coronary arterial flow patterns were strongly influenced by dominance and systemic/pulmonary hypertension; 2) dominance had minor effects on left coronary arterial and all microvascular flow patterns (aside from mean circumflex flow); 3) although systemic hypertension favorably increased perfusion pressure, this benefit varied regionally and transmurally and was offset by increased left ventricular and septal flow demands; and 4) pulmonary hypertension had a substantial negative effect on right ventricular and septal flows, which was exacerbated by greater metabolic demands. These findings highlight the importance of interactions between coronary arterial dominance and hypertension in modulating coronary hemodynamics.

  16. Retinal Microvascular Abnormalities in Neurofibromatosis Type 1 Associated with Congenital Retinal Macrovessels

    Science.gov (United States)

    Makino, Shinji; Endoh, Katsuhisa; Tampo, Hironobu

    2013-01-01

    Here, we report a case of retinal microvascular abnormalities in a patient with neurofibromatosis type 1 (NF1) associated with congenital retinal macrovessels. An abnormal retinal macrovessel, crossing the macula horizontally, was detected in the right eye. Additionally, retinal microvascular abnormalities were detected. Eight years after the initial visit, the retinal microvascular abnormalities were noted to have changed substantially. We speculate that retinal microvascular abnormalities in NF1 may change dynamically over the years. PMID:23781366

  17. Retinal Microvascular Abnormalities in Neurofibromatosis Type 1 Associated with Congenital Retinal Macrovessels

    Directory of Open Access Journals (Sweden)

    Shinji Makino

    2013-01-01

    Full Text Available Here, we report a case of retinal microvascular abnormalities in a patient with neurofibromatosis type 1 (NF1 associated with congenital retinal macrovessels. An abnormal retinal macrovessel, crossing the macula horizontally, was detected in the right eye. Additionally, retinal microvascular abnormalities were detected. Eight years after the initial visit, the retinal microvascular abnormalities were noted to have changed substantially. We speculate that retinal microvascular abnormalities in NF1 may change dynamically over the years.

  18. Impact of uncontrolled blood pressure on diagnostic accuracy of coronary flow reserve for detecting significant coronary stenosis in hypertensive patients

    Institute of Scientific and Technical Information of China (English)

    LI Wei-hong; XU Wei-xian; LI Zhao-ping; LI Cui-ping; WANG Xin-yu; HE Li-yun; ZHAO Wei

    2013-01-01

    Baciground Impaired coronary flow reserve (CFR) in patients with hypertension may be caused by epicardial coronary stenosis or microvascular dysfunction.Antihypertensive treatment has been shown to improve coronary microvascular dysfunction.The aim of this study was to evaluate the impact of uncontrolled blood pressure (BP) on diagnostic accuracy of CFR for detecting significant coronary stenosis.Methods A total of 98 hypertensive patients scheduled for coronary angiography (CAG) due to chest pain were studied.Of them,45 patients had uncontrolled BP (defined as the office BP >140/90 mmHg (1 mmHg=0.133 kPa) in general hypertensive patients,or >130/80 mmHg in hypertensive individuals with diabetes mellitus),and the remaining 53 patients had well-controlled BP.CFR was measured in the left anterior descending coronary artery (LAD) during adenosine triphosphate-induced hyperemia by non-invasive transthoracic Doppler echocardiography (TTDE) within 48 hours prior to CAG.Significant LAD stenosis was defined as >70% luminal narrowing.Diagnostic accuracy of CFR for detecting significant coronary stenosis was analyzed with a receiver operating characteristic analysis.Results CFR was significantly lower in patients with uncontrolled BP than in those with well-controlled BP (2.1±0.6 vs.2.6±0.9,P <0.01).Multivariate linear regression analysis of the study showed that the value of CFR was independently associated with the angiographically determined degree of LAD stenosis (β=-0.445,P <0.0001) and the presence of uncontrolled BP (β=-0.272,P=0.014).With a receiver operating characteristic analysis,CFR <2.2 was the optimal cut-off value for detecting LAD stenosis in all hypertensive patients (AUC 0.83,95%C/0.75-0.91) with a sensitivity of 75%,a specificity of 78%,and an accuracy of 77%.A significant reduction of diagnostic specificity was observed in patients with uncontrolled BP compared with those with well-controlled BP (67% vs.93%,P=0

  19. Which side of the balance determines the frequency of vaso-occlusive crises in children with sickle cell anemia: Blood viscosity or microvascular dysfunction?

    Science.gov (United States)

    Charlot, Keyne; Romana, Marc; Moeckesch, Berenike; Jumet, Stéphane; Waltz, Xavier; Divialle-Doumdo, Lydia; Hardy-Dessources, Marie-Dominique; Petras, Marie; Tressières, Benoît; Tarer, Vanessa; Hue, Olivier; Etienne-Julan, Maryse; Antoine-Jonville, Sophie; Connes, Philippe

    2016-01-01

    Vascular resistance and tissue perfusion may be both affected by impaired vascular function and increased blood viscosity. Little is known about the effects of vascular function on the occurrence of painful vaso-occlusive crises (VOC) in children with sickle cell anemia (SCA). The aim of the present study was to determine which side of the balance (blood viscosity or vascular function) is the most deleterious in SCA and increases the risk for frequent hospitalized VOC. Microvascular function, microcirculatory oxygenation and blood viscosity were determined in a group of 22 SCA children/adolescents at steady state and a group of 13 healthy children/adolescents. Univariate analyses demonstrated blunted microvascular reactivity during local thermal heating test and decreased microcirculatory oxygenation in SCA children compared to controls. Multivariate analysis revealed that increased blood viscosity and decreased microcirculatory oxygenation were independent risk factors of frequent VOC in SCA. In contrast, the level of microvascular dysfunction does not predict VOC rate. In conclusion, increased blood viscosity is usually well supported in healthy individuals where vascular function is not impaired. However, in the context of SCA, microvascular function is impaired and any increase of blood viscosity or decrease in microcirculatory oxygenation would increase the risks for frequent VOC.

  20. Head to Head Comparison of Two Point-of-care Platelet Function Tests Used for Assessment of On-clopidogrel Platelet Reactivity in Chinese Acute Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Yi Yao

    2016-01-01

    Conclusions: By comparing VerifyNow to TEG which has been widely used in clinics, VerifyNow could be an attractive alternative to TEG for monitoring on-clopidogrel platelet reactivity in Chinese patients.

  1. Telmisartan protects against microvascular dysfunction during myocardial ischemia/reperfusion injury by activation of peroxisome proliferator-activated receptor gamma

    Science.gov (United States)

    2013-01-01

    Background We investigated the potential of telmisartan to improve microvascular dysfunction induced by myocardial ischemia/reperfusion (I/R) injury by activating the peroxisome proliferator-activated receptor gamma (PPARG) pathway. Methods Forty-eight male rabbits were randomly allocated into sham-operated, I/R, GW9662, telmisartan, telmisartan–GW9662, or candesartan groups. Rabbits were anesthetized, and the left anterior descending coronary artery (LAD) was ligated for 60 minutes. Following reperfusion for 6 hours, angiotensin II content of the heart was determined using radioimmunoassay. Myocardial neutrophil accumulation and microvessel cross-sectional area were examined histologically. Myocardial capillaries were examined with transmission electron microscopy. Intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) in the myocardium were measured using enzyme-linked immunosorbent assay. Western blot was utilized for investigating the expression of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and PPARG. Results Angiotensin II concentration was significantly increased in all treatment groups compared with the sham-operated group (P telmisartan, telmisartan-GW9662, and candesartan groups compared with the I/R group (P telmisartan group compared with the telmisartan–GW9662 and candesartan groups. Telmisartan significantly increased PPARG protein expression compared with all other groups (P telmisartan improved microvascular dysfunction during myocardial I/R injury via the PPARG pathway. PMID:23738781

  2. 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.)

  3. Chronic elevation of pulmonary microvascular pressure in chronic heart failure reduces bi-directional pulmonary fluid flux.

    Science.gov (United States)

    Dixon, Dani-Louise; Mayne, George C; Griggs, Kim M; De Pasquale, Carmine G; Bersten, Andrew D

    2013-04-01

    Chronic heart failure leads to pulmonary vascular remodelling and thickening of the alveolar-capillary barrier. We examined whether this protective effect may slow resolution of pulmonary oedema consistent with decreased bi-directional fluid flux. Seven weeks following left coronary artery ligation, we measured both fluid flux during an acute rise in left atrial pressure (n = 29) and intrinsic alveolar fluid clearance (n = 45) in the isolated rat lung. Chronic elevation of pulmonary microvascular pressure prevented pulmonary oedema and decreased lung compliance when left atrial pressure was raised to 20 cmH2O, and was associated with reduced expression of endothelial aquaporin 1 (P = 0.03). However, no other changes were found in mediators of fluid flux or cellular fluid channels. In isolated rat lungs, chronic LV dysfunction (LV end-diastolic pressure and infarct circumference) was also inversely related to alveolar fluid clearance (P ≤ 0.001). The rate of pulmonary oedema reabsorption was estimated by plasma volume expansion in eight patients with a previous clinical history of chronic heart failure and eight without, who presented with acute pulmonary oedema. Plasma volume expansion was reduced at 24 h in those with chronic heart failure (P = 0.03). Chronic elevation of pulmonary microvascular pressure in CHF leads to decreased intrinsic bi-directional fluid flux at the alveolar-capillary barrier. This adaptive response defends against alveolar flooding, but may delay resolution of alveolar oedema.

  4. 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.

  5. Coronary heart disease

    Science.gov (United States)

    Heart disease, Coronary heart disease, Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD ... slow down or stop. A risk factor for heart disease is something that increases your chance of getting ...

  6. Protective effects of quercetin on rat pial microvascular changes during transient bilateral common carotid artery occlusion and reperfusion.

    Directory of Open Access Journals (Sweden)

    Dominga eLapi

    2012-03-01

    Full Text Available The aim of this study was to assess the in vivo effects of quercetin on pial microvascular responses during transient bilateral common carotid artery occlusion (BCCAO and reperfusion. Rat pial microcirculation was visualized by fluorescence microscopy through a closed cranial window. Pial arterioles were classified in five orders of branchings. Capillaries were assigned order 0, the smallest arterioles order 1 and the largest ones order 5. In ischemic rats, 30 min BCCAO and 60 min reperfusion caused arteriolar diameter decrease (by 14.5 ± 3.3% of baseline in order 2, microvascular leakage (0.47 ± 0.04 NGL: Normalized Grey Levels, leukocyte adhesion in venules (9 ± 2/100 µm venular length, v.l./30s and reduction of capillary perfusion (by 40 ± 7% of baseline. Moreover, at the end of BCCAO and reperfusion there was a significant increase in reactive oxygen species formation (ROS when compared with baseline. Quercetin highest dose determined dilation in all arteriolar orders (by 40 ± 4 % of baseline in order 2 and prevented microvascular permeability (0.15 ± 0.02 NGL, leukocyte adhesion (3 ± 1/100 µm v.l./30s as well as ROS formation, while capillary perfusion was protected. Inhibition of endothelial Nitric Oxide Synthase (NOS prior to quercetin reduced arteriolar dilation (order 2 diameter increase by 10.3 ± 2.5% of baseline and caused permeability increase (0.29 ± 0.03 NGL; inhibition of neuronal NOS or inducible NOS did not affect quercetin-induced effects. Inhibition of guanylyl cyclase prior to quercetin reversed the quercetin’s effects on pial arteriolar diameter and leakage. In conclusion, quercetin was able to protect pial microcirculation from ischemia-reperfusion damage inducing arteriolar dilation likely by nitric oxide release. Moreover, quercetin scavenger activity blunted reactive oxygen species formation preserving the blood-brain barrier integrity.

  7. Coronary heart disease

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008417 Efficacy comparison with low and high dose natroparin for patients with acute coronary syndrome underwent percutancous coronary intervention. SUN Chaoyu(孙超宇), et al. Dept Cardiol, 4th Affili Hosp, Harbin Med Univ, Harbin 150001. Chin J Cardiol 2008;36(6):493-496. Objective To evaluate the safety and optimal piror percutaneous coronary intervention (PCI) natroparin dose in patients with acute coronary syndrome (ACS).

  8. Coronary CTA assessment of coronary anomalies.

    NARCIS (Netherlands)

    Pursnani, A.; Jacobs, J.E.; Saremi, F.; Levisman, J.; Makaryus, A.N.; Capunay, C.; Rogers, I.S.; Wald, C.; Azmoon, S.; Stathopoulos, I.A.; Srichai, M.B.

    2012-01-01

    Coronary anomalies occur in <1% of the general population and can range from a benign incidental finding to the cause of sudden cardiac death. The coronary anomalies are classified here according to the traditional grouping into those of origin and course, intrinsic arterial anatomy, and

  9. Coronary CTA assessment of coronary anomalies.

    NARCIS (Netherlands)

    Pursnani, A.; Jacobs, J.E.; Saremi, F.; Levisman, J.; Makaryus, A.N.; Capunay, C.; Rogers, I.S.; Wald, C.; Azmoon, S.; Stathopoulos, I.A.; Srichai, M.B.

    2012-01-01

    Coronary anomalies occur in <1% of the general population and can range from a benign incidental finding to the cause of sudden cardiac death. The coronary anomalies are classified here according to the traditional grouping into those of origin and course, intrinsic arterial anatomy, and terminat

  10. 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...

  11. Microvascular networks for continuous self-healing materials

    Science.gov (United States)

    Toohey, Kathleen Suzanne

    Microcapsule-based and hollow glass fiber-based self-healing composites enable a single repair of crack damage in a given location. Re-mendable polymers have demonstrated crack mending for multiple cycles, but only with heat treatment and applied pressure. We demonstrate, for the first time, the autonomic characteristics of microencapsulated systems with the ability to heal repeated damage events in a continuous self-healing coating on a microvascular substrate. A three-dimensional, interconnected microvascular network in the substrate serves as a delivery system for healing materials to heal damage in a polymer coating. Two approaches to microvascular delivery are explored: one using a fluid monomer in the network with solidphase catalyst particles in the coating, and one using two or more separate networks with two fluid healing components. In both systems, the fluid(s) flow from the microchannels into the crack plane through capillary action, and polymerization occurs to heal the crack. In the single-fluid system, a single crack in a brittle epoxy coating is healed as many as seven times, and the ability to heal continuously is limited only by the availability of catalyst. The two-part healing system contained in separate networks in a specimen has significant potential to extend the repeatability of the healing process due to the microvascular supply of both healing components. Preliminary tests of this two-part system demonstrate that multiple healing cycles are possible.

  12. Repeat microvascular decompression for recurrent idiopathic trigeminal neuralgia

    NARCIS (Netherlands)

    Bakker, Nicolaas A.; van Dijk, J. Marc C.; Immenga, Steven; Wagemakers, Michiel; Metzemaekers, Jan D. M.

    2014-01-01

    Object. Microvascular decompression (MVD) is considered the method of choice to treat idiopathic trigeminal neuralgia (TN) refractory to medical treatment. However, repeat MVD for recurrent TN is not well established. In this paper, the authors describe a large case series in which patients underwen

  13. Vitamin D and retinal microvascular damage: The Rotterdam Study

    NARCIS (Netherlands)

    Mutlu, U.; Ikram, M.A.; Hofman, A.; Jong, P.T.; Uitterlinden, A.G.; Klaver, C.C.W.; Ikram, M.K.

    2016-01-01

    Vitamin D has been linked to various cardiovascular risk factors including indices of large-vessel disease. However, it remains unclear whether vitamin D is also associated with microvascular damage. In a community-dwelling population, we studied associations between vitamin D serum levels and

  14. 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

  15. Effect of Erythropoietin on Microvascular Anastomosis in Rat

    African Journals Online (AJOL)

    accelerated re-endothelialization in rat femoral arteries following microvascular anastomosis. Keywords: .... significance levels were two-tailed and set at p <. 0.05. ... vein endothelial cell (HUVEC) cultures in ... injection, to maintain a high EPO concentration in blood, the .... replacement for endothelial cells in the rabbit. Circ.

  16. Repeat microvascular decompression for recurrent idiopathic trigeminal neuralgia

    NARCIS (Netherlands)

    Bakker, Nicolaas A.; van Dijk, J. Marc C.; Immenga, Steven; Wagemakers, Michiel; Metzemaekers, Jan D. M.

    2014-01-01

    Object. Microvascular decompression (MVD) is considered the method of choice to treat idiopathic trigeminal neuralgia (TN) refractory to medical treatment. However, repeat MVD for recurrent TN is not well established. In this paper, the authors describe a large case series in which patients

  17. Vitamin D and retinal microvascular damage : The Rotterdam Study

    NARCIS (Netherlands)

    Mutlu, Unal; Ikram, M Arfan; Hofman, Albert; de Jong, Paulus T V M; Uitterlinden, Andre G; Klaver, Caroline C W; Ikram, M Kamran

    2016-01-01

    Vitamin D has been linked to various cardiovascular risk factors including indices of large-vessel disease. However, it remains unclear whether vitamin D is also associated with microvascular damage. In a community-dwelling population, we studied associations between vitamin D serum levels and retin

  18. 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

  19. 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.

  20. Determination and clinical significance of serum hypersensitivity C-reactive protein and hypersensitivity cardiac troponin in patients with coronary heart disease%冠心病患者血清超敏C-反应蛋白、超敏肌钙蛋白T检测及意义

    Institute of Scientific and Technical Information of China (English)

    戴仁森; 李伟林

    2013-01-01

    Objective To research the determination of hypersensitivity C-reactive protein(Hs-CRP) and cardiac troponin T(Hs-cTnT) in patients with coronary heart disease,and to analyze the correlation with cardiac function.Methods The function of left ventricle and the serum levels of Hs-CRP and Hs-cTnT in 100 patients with coronary heart disease and 50 healthy subjects were detected.Results The function of left ventricle and the serum levels of Hs-CRP and Hs-cTnT were significantly different in patients with coronary heart disease and healthy subjects(P <0.01).The function of left ventricle and the serum levels of Hs-CRP and Hs-cTnT were significantly different in coronary heart disease patients with different New York Heart Association class(P < 0.01).The serum levels of Hs-CRP and Hs-cTnT were positively correlated with class of New York Heart Association,left ventricular end diastolic diameter,and negatively correlated with left ventricular ejection fraction and fraction shortening (Absolute value of r:0.536 ~ 0.849,P < 0.05).Conclusion The serum levels of Hs-CRP and Hs-cTnT significantly increase in patients with coronary heart disease,which is correlated to function of left ventricle,and it can be used as the indicators of cardiac function in patients with coronary heart disease.%目的 研究冠心病患者血清超敏C-反应蛋白(Hs-CRP)、超敏肌钙蛋白T(Hs-cTnT)的测定及分析两者与左心室功能的关系.方法 100例冠心病患者(观察组)和50例(对照组)年龄相当的健康受试者纳入该研究,分别测定左心室功能以及血清Hs-CRP和Hs-cTnT水平.结果 与对照组相比,观察组Hs-CRF和Hs-cTnT水平明显升高(t=11.745、7.803,均P<0.01),观察组左室舒张末内径(LVEDD)水平显著升高(t =4.984,P<0.01),而左室射血分数(LVEF)和左室短轴缩短率(FS)均显著降低(t=5.021、4.672,均P<0.01).观察组不同YNHA分级,其Hs-CRF、Hs-cTnT水平、LVEF、LVEDD及FS等差异均有统计学意义(F=89

  1. Matrix metalloproteinase-9 in patients with acute coronary syndrome

    Institute of Scientific and Technical Information of China (English)

    Regent Lee

    2012-01-01

    To the Editor:I congratulate Wang et al1 in reporting further evidence for the role of matrix metalloproteinase-9 (MMP9)as a biomarker in acute coronary syndrome (ACS).In this study,the Authors examined the levels of MMP9 and C-reactive protein (CRP) in patients with a clinical diagnosis of unstable angina pectoris who subsequently underwent coronary angiography to evaluate the presence of coronary artery disease.Two subgroups of patients were defined according to the presence or absence of significant angiographic coronary artery stenosis.The level of MMP9 was significantly higher in patients with angiographic evidence of significant plaque disease (plaque group) compared with those without significant coronary stenosis (non-plaque group).No significant differences in the levels of CRP were observed between the two groups.

  2. 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.

  3. Dynamic contrast-enhanced MRI assessment of hyperemic fractional microvascular blood plasma volume in peripheral arterial disease: initial findings.

    Directory of Open Access Journals (Sweden)

    Bas Versluis

    Full Text Available OBJECTIVES: The aim of the current study was to describe a method that assesses the hyperemic microvascular blood plasma volume of the calf musculature. The reversibly albumin binding contrast agent gadofosveset was used in dynamic contrast-enhanced magnetic resonance imaging (DCE MRI to assess the microvascular status in patients with peripheral arterial disease (PAD and healthy controls. In addition, the reproducibility of this method in healthy controls was determined. MATERIALS AND METHODS: Ten PAD patients with intermittent claudication and 10 healthy control subjects were included. Patients underwent contrast-enhanced MR angiography of the peripheral arteries, followed by one DCE MRI examination of the musculature of the calf. Healthy control subjects were examined twice on different days to determine normative values and the interreader and interscan reproducibility of the technique. The MRI protocol comprised dynamic imaging of contrast agent wash-in under reactive hyperemia conditions of the calf musculature. Using pharmacokinetic modeling the hyperemic fractional microvascular blood plasma volume (V(p, unit: % of the anterior tibial, gastrocnemius and soleus muscles was calculated. RESULTS: V(p was significantly lower for all muscle groups in PAD patients (4.3±1.6%, 5.0±3.3% and 6.1±3.6% for anterior tibial, gastrocnemius and soleus muscles, respectively compared to healthy control subjects (9.1±2.0%, 8.9±1.9% and 9.3±2.1%. Differences in V(p between muscle groups were not significant. The coefficient of variation of V(p varied from 10-14% and 11-16% at interscan and interreader level, respectively. CONCLUSIONS: Using DCE MRI after contrast-enhanced MR angiography with gadofosveset enables reproducible assessment of hyperemic fractional microvascular blood plasma volume of the calf musculature. V(p was lower in PAD patients than in healthy controls, which reflects a promising functional (hemodynamic biomarker for the

  4. Measurement of pulmonary flow reserve and pulmonary index of microcirculatory resistance for detection of pulmonary microvascular obstruction.

    Directory of Open Access Journals (Sweden)

    Rahn Ilsar

    Full Text Available BACKGROUND: The pulmonary microcirculation is the chief regulatory site for resistance in the pulmonary circuit. Despite pulmonary microvascular dysfunction being implicated in the pathogenesis of several pulmonary vascular conditions, there are currently no techniques for the specific assessment of pulmonary microvascular integrity in humans. Peak hyperemic flow assessment using thermodilution-derived mean transit-time (T(mn facilitate accurate coronary microcirculatory evaluation, but remain unvalidated in the lung circulation. Using a high primate model, we aimed to explore the use of T(mn as a surrogate of pulmonary blood flow for the purpose of measuring the novel indices Pulmonary Flow Reserve [PFR = (maximum hyperemic/(basal flow] and Pulmonary Index of Microcirculatory Resistance [PIMR = (maximum hyperemic distal pulmonary artery pressurex(maximum hyperemic T(mn]. Ultimately, we aimed to investigate the effect of progressive pulmonary microvascular obstruction on PFR and PIMR. METHODS AND RESULTS: Temperature- and pressure-sensor guidewires (TPSG were placed in segmental pulmonary arteries (SPA of 13 baboons and intravascular temperature measured. T(mn and hemodynamics were recorded at rest and following intra-SPA administration of the vasodilator agents adenosine (10-400 microg/kg/min and papaverine (3-24 mg. Temperature did not vary with intra-SPA sensor position (0.010+/-0.009 v 0.010+/-0.009 degrees C; distal v proximal; p = 0.1, supporting T(mn use in lung for the purpose of hemodynamic indices derivation. Adenosine (to 200 microg/kg/min & papaverine (to 24 mg induced dose-dependent flow augmentations (40+/-7% & 35+/-13% T(mn reductions v baseline, respectively; p<0.0001. PFR and PIMR were then calculated before and after progressive administration of ceramic microspheres into the SPA. Cumulative microsphere doses progressively reduced PFR (1.41+/-0.06, 1.26+/-0.19, 1.17+/-0.07 & 1.01+/-0.03; for 0, 10(4, 10(5 & 10(6 microspheres; p

  5. Short- and long-term effects of silver nanoparticles on human microvascular endothelial cells

    Institute of Scientific and Technical Information of China (English)

    Sara; Castiglioni; Clelia; Caspani; Alessandra; Cazzaniga; Jeanette; AM; Maier

    2014-01-01

    AIM: To study the response to silver nanoparticles(Ag NP) of human microvascular endothelial cells, protagonists of angiogenesis. METHODS: We cultured human microvascular endothelial cells and endothelial colony-forming cells in their corresponding growth medium. Stock solutions of Ag NP were prepared in culture medium and sonicated before use. They were added at different concentrations and for different times to culture media. The toxicity of Ag NP was investigated by measuring the reduction of yellow tetrazolium salt to dark purple formazan(MTT assay) at 575 nm. After staining with trypan blue, cell proliferation was assessed by counting viable cells. The lactate dehydrogenase leakage assay was performed on culture media by following the oxidation of NADH to NAD+ and monitoring the reaction kinetically at 340 nm. Reactive oxygen species production was quantified using 2’-7’-dichlorofluorescein diacetate. The alkaline comet assay was performed after mixing the cells with low melting-point agarose. Electrophoresis was then conducted and the samples were stained with ethidium bromide and analyzed with a fluorescence microscope.RESULTS: Ag NP are cytotoxic in a dose and time dependent fashion for HMEC. At high concentrations, Ag NP determine loss of membrane integrity as demonstrated by the increased activity of lactate dehydrogenase in the culture medium. Ag NP rapidly stimulate the formation of free radicals. However, pre-incubation with Trolox, apocynin, or N-acetyl-L-cysteine, antioxidants which have different structure and act through different mechanisms, is not sufficient to prevent cytotoxicity. Ag NP also induce DNA damage dose-dependently, as shown by comet assay. When exposed to sublethal concentrations of Ag NP for long times, the cells remain viable but are growth retarded. Interestingly, removal of Ag NP partially rescues cell growth. Also genotoxicity is reversible upon removal of Ag NP from culture medium, suggesting that no permanent

  6. Impact of individual and cumulative coronary risk factors on coronary flow reserve assessed by dobutamine stress echocardiography.

    Science.gov (United States)

    Ahmari, Saeed A L; Bunch, T Jared; Modesto, Karen; Stussy, Vicky; Dichak, Amy; Seward, James B; Pellikka, Patricia A; Chandrasekaran, Krishnaswamy

    2008-06-15

    Traditional cardiovascular risk factors have been shown to cause microvascular dysfunction. Most studies that have evaluated microcirculation rely on invasive measurement tools. We used dobutamine stress echocardiography, a validated method to measure coronary flow velocity (CFV) and coronary flow reserve (CFR), in a previously unstudied population without known significant coronary artery disease to determine the impact of traditional risk factors on CFR. Consecutive patients who had no evidence of regional wall motion abnormalities at rest or during dobutamine stress echocardiography were studied. Left anterior descending artery CFV was measured at baseline and at peak dobutamine stress and CFR was calculated as the ratio of peak stress CFV to baseline CFV. Fifty-nine consecutive patients (28 men) with mean age of 66.8+/-14.5 years were studied. CFR was lower in patients with diabetes mellitus (DM) compared with those without (1.7+/-0.74 vs 2.48+/-0.98, p50 mm Hg), and obesity with a wide pulse pressure. In a multivariate model, DM, obesity, and wide pulse pressure were significantly associated with variation in CFR (p<0.0008). In conclusion, CFR was abnormal in patients with DM, hypertension, and obesity. CFR impairment is exaggerated as the number of risk factors increases. Despite a negative dobutamine stress echocardiographic result, aggressive risk factor assessment and control should be implemented in patients with coronary risk factors due to an underlying abnormal CFR.

  7. Exploring Coronary Circulatory Response to Stenosis and Its Association with Invasive Physiologic Indices Using Absolute Myocardial Blood Flow and Coronary Pressure.

    Science.gov (United States)

    Lee, Joo Myung; Hwang, Doyeon; Park, Jonghanne; Zhang, Jinlong; Tong, Yaliang; Kim, Chee Hae; Bang, Ji-In; Suh, Minseok; Paeng, Jin Chul; Cheon, Gi Jeong; Koo, Bon-Kwon

    2017-08-29

    Background -Although invasive physiologic assessment for coronary stenosis has become a standard practice to guide treatment strategy, coronary circulatory response and changes in invasive physiologic indices, according to different anatomical and hemodynamic lesion severity, have not been fully demonstrated in patients with coronary artery disease. Methods -One hundred fifteen patients with left anterior descending artery stenosis who underwent both (13)N-ammonia positron emission tomography (PET) and invasive physiologic measurement were analyzed. Myocardial blood flow (MBF) measured using PET and invasively measured coronary pressures were used to calculate microvascular resistance (MVR) and stenosis resistance. Results -With progressive worsening of angiographic stenosis severity, both resting and hyperemic trans-stenotic pressure gradient and stenosis resistance increased (Pstenosis severity, stenosis resistance, and trans-stenotic pressure gradient increased, and hyperemic MBF decreased (all P valuescoronary flow reserve (CFR), the diagnostic accuracy of FFR and iFR did not differ, regardless of cut-off values of hyperemic MBF and CFR. Conclusions -This study demonstrated how the coronary circulation changes in response to increasing coronary stenosis severity using (13)N-ammonium PET-derived MBF and invasively measured pressure data. Currently used resting and hyperemic pressure-derived invasive physiologic indices have similar patterns of relationships to the different anatomic and hemodynamic lesion severity. Clinical Trial Registration -URL: https://clinicaltrials.gov Unique Identifier: NCT01366404.

  8. The coronary heart team.

    Science.gov (United States)

    Yanagawa, Bobby; Puskas, John D; Bhatt, Deepak L; Verma, Subodh

    2017-09-01

    The concept of a Coronary Heart Team has generated increased interest, including support from major practice guidelines. Here, we review the rationale and the published experience of Coronary Heart Teams. A Coronary Heart Team should be led by both cardiology and cardiac surgery with a shared decision-making approach. The team should incorporate data from anatomic and clinical risk prediction models to offer individualized care. Most teams focus on management of complex patients and those with indications for both coronary artery bypass graft and percutaneous coronary intervention. The potential benefits of a Coronary Heart Team include balanced decision-making, greater adherence to evidence-based practice guidelines, as well as promoting greater collegiality and exchange of knowledge between specialties. Single-center series have demonstrated consistency in decision-making by Coronary Heart Teams but prospective data demonstrating improved patient outcomes and/or cost effectiveness are necessary. The concept of a Coronary Heart Team is gaining traction for patients with complex coronary artery disease. There is a growing literature in support of Coronary Heart Teams but comparative and prospective data demonstrating improved patient outcomes are needed.

  9. [Microvascular angina in women: a diagnostic and therapeutic challenge

    NARCIS (Netherlands)

    Elias-Smale, S.E.; Boer, M.J. de; Maas, A.H.E.M.

    2014-01-01

    Gender differences play an important role in coronary heart disease (CHD). Not only in the presentation of symptoms, but also in their underlying pathophysiology. Women with persistent angina without obstructive coronary artery disease (CAD) pose a diagnostic and therapeutic challenge. Half of these

  10. Complete blood cell count components and coronary slow-flow phenomenon

    Directory of Open Access Journals (Sweden)

    Arjmand N

    2016-12-01

    Full Text Available Nasim Arjmand, Mohammad Reza Dehghani Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, IranDespite the implementation of preventive strategies, ischemic heart disease and stroke remain the main causes of mortality and morbidity worldwide.1,2 Of the cardiovascular diseases, coronary slow-flow phenomenon (CSFP, with a prevalence rate of 1%–7% among patients undergoing diagnostic coronary angiography, has been found to be associated with cardiovascular events, including cardiac arrhythmia and acute coronary syndrome.3–5 However, the potential mechanisms involved in the pathogenesis of CSFP remain unknown. Microvascular and endothelial dysfunctions, inflammation, diffuse atherosclerosis, and increased platelet aggregability have been reported to be the main possible etiologies for CSFP.6,7View original paper by Atlas and colleagues.

  11. 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.

  12. Coronary Artery Disease

    DEFF Research Database (Denmark)

    Christiansen, Morten Krogh

    2017-01-01

    A family history of coronary artery disease (CAD) is an important risk factor for adverse coronary events, in particular if the disease has an early onset. The risk of CAD is influenced by genetic and environmental factors with a greater genetic contribution earlier in life. Through recent years...... Registry and risk factor control was evaluated. The study revealed that risk factors are common in early-onset CAD and that a large room for risk factor improvement remains. In study II, we used coronary computed tomography angiography to compare the coronary plaque burden and characteristics between 88...... first-degree relatives of patients with early-onset CAD and 88 controls with no familial predisposition. Relatives had a significantly increased coronary plaque burden, which displayed characteristics associated with myocardial ischemia and adverse coronary events. In study III, 134 patients with early...

  13. Living with Coronary Heart Disease

    Science.gov (United States)

    ... from the NHLBI on Twitter. Living With Coronary Heart Disease Coronary heart disease (CHD) can cause serious complications. However, if you ... changes and medicines, go to "How Is Coronary Heart Disease Treated?" Work closely with your doctor to control ...

  14. 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...

  15. Coronary Physiology During Exercise and Vasodilation in the Healthy Heart and in Severe Aortic Stenosis.

    Science.gov (United States)

    Lumley, Matthew; Williams, Rupert; Asrress, Kaleab N; Arri, Satpal; Briceno, Natalia; Ellis, Howard; Rajani, Ronak; Siebes, Maria; Piek, Jan J; Clapp, Brian; Redwood, Simon R; Marber, Michael S; Chambers, John B; Perera, Divaka

    2016-08-16

    Severe aortic stenosis (AS) can manifest as exertional angina even in the presence of unobstructed coronary arteries. The authors describe coronary physiological changes during exercise and hyperemia in the healthy heart and in patients with severe AS. Simultaneous intracoronary pressure and flow velocity recordings were made in unobstructed coronary arteries of 22 patients with severe AS (mean effective orifice area 0.7 cm(2)) and 38 controls, at rest, during supine bicycle exercise, and during hyperemia. Stress echocardiography was performed to estimate myocardial work. Wave intensity analysis was used to quantify waves that accelerate and decelerate coronary blood flow (CBF). Despite a greater myocardial workload in AS patients compared with controls at rest (12,721 vs. 9,707 mm Hg/min(-1); p = 0.003) and during exercise (27,467 vs. 20,841 mm Hg/min(-1); p = 0.02), CBF was similar in both groups. Hyperemic CBF was less in AS compared with controls (2,170 vs. 2,716 cm/min(-1); p = 0.05). Diastolic time fraction was greater in AS compared with controls, but minimum microvascular resistance was similar. With exercise and hyperemia, efficiency of perfusion improved in the healthy heart, demonstrated by an increase in the relative contribution of accelerating waves. By contrast, in AS, perfusion efficiency decreased due to augmentation of early systolic deceleration and an attenuated rise in systolic acceleration waves. Invasive coronary physiological evaluation can be safely performed during exercise and hyperemia in patients with severe aortic stenosis. Ischemia in AS is not related to microvascular disease; rather, it is driven by abnormal cardiac-coronary coupling. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  16. 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

  17. 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.

  18. Cell proliferation along vascular islands during microvascular network growth

    Directory of Open Access Journals (Sweden)

    Kelly-Goss Molly R

    2012-06-01

    Full Text Available Abstract Background Observations in our laboratory provide evidence of vascular islands, defined as disconnected endothelial cell segments, in the adult microcirculation. The objective of this study was to determine if vascular islands are involved in angiogenesis during microvascular network growth. Results Mesenteric tissues, which allow visualization of entire microvascular networks at a single cell level, were harvested from unstimulated adult male Wistar rats and Wistar rats 3 and 10 days post angiogenesis stimulation by mast cell degranulation with compound 48/80. Tissues were immunolabeled for PECAM and BRDU. Identification of vessel lumens via injection of FITC-dextran confirmed that endothelial cell segments were disconnected from nearby patent networks. Stimulated networks displayed increases in vascular area, length density, and capillary sprouting. On day 3, the percentage of islands with at least one BRDU-positive cell increased compared to the unstimulated level and was equal to the percentage of capillary sprouts with at least one BRDU-positive cell. At day 10, the number of vascular islands per vascular area dramatically decreased compared to unstimulated and day 3 levels. Conclusions These results show that vascular islands have the ability to proliferate and suggest that they are able to incorporate into the microcirculation during the initial stages of microvascular network growth.

  19. Delayed, bilateral, non-microvascular ear replantation after violent amputation.

    Science.gov (United States)

    García-Murray, E; Adán-Rivas, O; Salcido-Calzadilla, H

    2009-06-01

    Amputation of any body part is undoubtedly a traumatic experience leaving a terrible deformity, especially when the part or parts involved are visible and constitute an essential component of someone's facial whole. Bilateral ear amputation and successful subsequent replantation has been reported historically, but not in the modern surgical literature. We report the case of a 27-year-old female who was abducted and suffered a bilateral ear amputation at the hands of one of her captors to speed delivery of ransom money; the severed parts were sent to the parents approximately 2 hours after the amputation had taken place, and the girl was released some 48 hours after the ears were delivered. Microvascular replantation was attempted immediately after admission to the hospital some 2 hours after her release, but failed, and so a non-microvascular replantation was performed and was successful, after approximately 54 hours of ischaemia time. We consider this the first report of a complete bilateral, delayed, non-microvascular, successful ear replantation in a human being in the modern literature.

  20. 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

  1. 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

  2. Antiproliferative effect of elevated glucose in human microvascular endothelial cells

    Science.gov (United States)

    Kamal, K.; Du, W.; Mills, I.; Sumpio, B. E.

    1998-01-01

    Diabetic microangiopathy has been implicated as a fundamental feature of the pathological complications of diabetes including retinopathy, neuropathy, and diabetic foot ulceration. However, previous studies devoted to examining the deleterious effects of elevated glucose on the endothelium have been performed largely in primary cultured cells of macrovessel origin. Difficulty in the harvesting and maintenance of microvascular endothelial cells in culture have hindered the study of this relevant population. Therefore, the objective of this study was to characterize the effect of elevated glucose on the proliferation and involved signaling pathways of an immortalized human dermal microvascular endothelial cell line (HMEC-1) that possess similar characteristics to their in vivo counterparts. Human dermal microvascular endothelial cells (HMEC-1) were grown in the presence of normal (5 mM) or high D-glucose (20 mM) for 14 days. The proliferative response of HMEC-1 was compared under these conditions as well as the cAMP and PKC pathways by in vitro assays. Elevated glucose significantly inhibited (P diabetic microangiopathy.

  3. [Microvascular anastomoses in reconstructive head and neck surgery].

    Science.gov (United States)

    Remmert, S

    1995-04-01

    At the ENT Department of the University of Lübeck, 57 microvascular tissue transplants with 129 anastomoses (61 arterial and 68 venous) have been performed in the last three years. Arteries have always been anastomosed end to end. The venous anastomoses have primarily been performed as end-to-side unions with the jugular vein. In nine patients, great distances between the donor and recipient vessel had to be connected with venous interponates. In two cases in which veins were lacking in the neck after radical neck dissection or radiation fibrosis, we used the cephalic vein or veins of the capsule of the thyroid gland as recipient vessels. The jejunal or osteomyocutaneous transplants were first fitted into the defect before performing the anastomosis. The jejunal peristalsis and the required freedom of movement in shaping the bone necessitated this technique. Microvascular anastomosis was first performed on the transplant of the radialis flap and the neurovascular infrahyoid muscular flap, and then they were integrated into the defect. We lost two transplants postoperatively because of venous thrombosis. In this article wie describe our anastomosis technique, the frequency distribution of recipient vessels, and the rules and characteristics of microvascular anastomosis after radiation and neck dissection.

  4. Microvascular Architecture of Hepatic Metastases in a Mouse Model

    Directory of Open Access Journals (Sweden)

    Darshini Kuruppu

    1997-01-01

    Full Text Available Development of effective treatment for hepatic metastases can be initiated by a better understanding of tumour vasculature and blood supply. This study was designed to characterise the microvascular architecture of hepatic metastases and observe the source of contributory blood supply from the host. Metastases were induced in mice by an intrasplenic injection of colon carcinoma cells (106 cells/ml. Vascularization of tumours was studied over a three week period by scanning electron microscopy of microvascular corrosion casts. Metastatic liver involvement was observed initially within a week post induction, as areas approximately 100 μm in diameter not perfused by the casting resin. On histology these spaces corresponded to tumour cell aggregates. The following weeks highlighted the angiogenesis phase of these tumours as they received a vascular supply from adjacent hepatic sinusoids. Direct sinusoidal supply of metastases was maintained throughout tumour growth. At the tumour periphery most sinusoids were compressed to form a sheath demarcating the tumour from the hepatic vasculature. No direct supply from the hepatic artery or the portal vein was observed. Dilated vessels termed vascular lakes dominated the complex microvascular architecture of the tumours, most tapering as they traversed towards the periphery. Four vascular branching patterns could be identified as true loops, bifurcations and trifurcations, spirals and capillary networks. The most significant observation in this study was the direct sinusoidal supply of metastases, together with the vascular lakes and the peripheral sinusoidal sheaths of the tumour microculature.

  5. Microfabrication of cylindrical microfluidic channel networks for microvascular research.

    Science.gov (United States)

    Huang, Zhouchun; Li, Xiang; Martins-Green, Manuela; Liu, Yuxin

    2012-10-01

    Current methods for formation of microvascular channel scaffolds are limited with non-circular channel cross-sections, complicated fabrication, and less flexibility in microchannel network design. To address current limitations in the creation of engineered microvascular channels with complex three-dimensional (3-D) geometries in the shape of microvessels, we have developed a reproducible, cost-effective, and flexible micromanufacturing process combined with photolithographic reflowable photoresist and soft lithography techniques to fabricate cylindrical microchannel and networks. A positive reflowable photoresist AZ P4620 was used to fabricate a master microchannel mold with semi-circular cross-sections. By the alignment and bonding of two polydimethylsiloxane (PDMS) microchannels replicated from the master mold together, a cylindrical microchannel or microchannel network was created. Further examination of the channel dimensions and surface profiles at different branching levels showed that the shape of the microfluidic channel was well approximated by a semi-circular surface, and a multi-level, multi-depth channel network was created. In addition, a computational fluidic dynamics (CFD) model was used to simulate shear flows and corresponding pressure distributions inside of the microchannel and channel network based on the dimensions of the fabricated channels. The fabricated multi-depth cylindrical microchannel network can provide platforms for the investigation of microvascular cells growing inside of cylindrical channels under shear flows and lumen pressures, and work as scaffolds for the investigation of morphogenesis and tubulogenesis.

  6. 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.

  7. Early experiences with microvascular free tissue transfer in Lagos, Nigeria

    Directory of Open Access Journals (Sweden)

    Bolaji O Mofikoya

    2014-01-01

    Full Text Available Objectives: Microvascular free tissue transfer within our subregion is fraught with considerable challenges. We aim to highlight our experiences gained with our first fifteen cases of microvascular free tissue transfer at the Lagos University Teaching Hospital. We believe our report will be useful to colleagues embarking on such reconstructions in similar settings. Materials and Methods: The clinical records of the first 15 cases of free flaps done at our center were reviewed. The indications for surgery, choice of flap, recipient vessels, duration of surgery and complications were noted. Results: Fifteen cases were done, 10 flaps survived, ten defects occurred following trauma while remaining five followed cancer resections. Anterolateral thigh and radial forearm flaps were the most common flap used. The mean duration of surgeries was 7.1 hours SD ± 1.10 hours. Our take back rate was 13.3%, with a salvage rate of 50%. Three flaps failed on account venous congestion while remaining two failed due to arterial occlusion. Conclusion: 66.67% free flap success rate recorded reflect our early experiences in our institution. We believe meticulous planning, careful vessel selection, close flap monitoring as well as improved infrastructural support can lead to much better success rates in microvascular reconstruction in our country.

  8. Evaluation of gravimetric techniques to estimate the microvascular filtration coefficient.

    Science.gov (United States)

    Dongaonkar, R M; Laine, G A; Stewart, R H; Quick, C M

    2011-06-01

    Microvascular permeability to water is characterized by the microvascular filtration coefficient (K(f)). Conventional gravimetric techniques to estimate K(f) rely on data obtained from either transient or steady-state increases in organ weight in response to increases in microvascular pressure. Both techniques result in considerably different estimates and neither account for interstitial fluid storage and lymphatic return. We therefore developed a theoretical framework to evaluate K(f) estimation techniques by 1) comparing conventional techniques to a novel technique that includes effects of interstitial fluid storage and lymphatic return, 2) evaluating the ability of conventional techniques to reproduce K(f) from simulated gravimetric data generated by a realistic interstitial fluid balance model, 3) analyzing new data collected from rat intestine, and 4) analyzing previously reported data. These approaches revealed that the steady-state gravimetric technique yields estimates that are not directly related to K(f) and are in some cases directly proportional to interstitial compliance. However, the transient gravimetric technique yields accurate estimates in some organs, because the typical experimental duration minimizes the effects of interstitial fluid storage and lymphatic return. Furthermore, our analytical framework reveals that the supposed requirement of tying off all draining lymphatic vessels for the transient technique is unnecessary. Finally, our numerical simulations indicate that our comprehensive technique accurately reproduces the value of K(f) in all organs, is not confounded by interstitial storage and lymphatic return, and provides corroboration of the estimate from the transient technique.

  9. Reactive Hypoglycemia

    Science.gov (United States)

    ... from low blood sugar (hypoglycemia) that occurs while fasting. Signs and symptoms of reactive hypoglycemia may include ... and very important. It's also important to include physical activity in your daily routine. Your doctor can help ...

  10. Reactive Arthritis

    Directory of Open Access Journals (Sweden)

    Eren Erken

    2013-06-01

    Full Text Available Reactive arthritis is an acute, sterile, non-suppurative and inflammatory arthropaty which has occured as a result of an infectious processes, mostly after gastrointestinal and genitourinary tract infections. Reiter syndrome is a frequent type of reactive arthritis. Both reactive arthritis and Reiter syndrome belong to the group of seronegative spondyloarthropathies, associated with HLA-B27 positivity and characterized by ongoing inflammation after an infectious episode. The classical triad of Reiter syndrome is defined as arthritis, conjuctivitis and urethritis and is seen only in one third of patients with Reiter syndrome. Recently, seronegative asymmetric arthritis and typical extraarticular involvement are thought to be adequate for the diagnosis. However, there is no established criteria for the diagnosis of reactive arthritis and the number of randomized and controlled studies about the therapy is not enough. [Archives Medical Review Journal 2013; 22(3.000: 283-299

  11. Coronary artery aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Koischwitz, D.; Harder, T.; Schuppan, U.; Thurn, P.

    1982-04-01

    Seven saccular coronary artery aneurysms have been demonstrated in the course of 1452 selective coronary artery angiograms. In six patients they were arterio-sclerotic; in one patient the aneurysm must have been congenital or of mycotic-embolic origin. The differential diagnosis between true aneurysms and other causes of vascular dilatation is discussed. Coronary artery aneurysms have a poor prognosis because of the possibility of rupture with resultant cardiac tamponade, or the development of thrombo-embolic myocardial infarction. These aneurysms can only be diagnosed by means of coronary angiography and require appropriate treatment.

  12. Selective Coronary Arteriography

    Science.gov (United States)

    Parker, John O.; Challis, Thomas W.; West, Roxroy O.

    1966-01-01

    The technique of selective coronary arteriography, as described originally by Sones, was employed in 255 patients. Successful catheterization of both coronary arteries was carried out in 88% of these patients, and in the last 100 examinations both coronary arteries were entered in 95 patients. Selective coronary arteriography is a useful diagnostic tool but is a potentially hazardous form of examination as we encountered four episodes of ventricular fibrillation in the present series. ImagesFig. 1Fig. 2Figs. 3A-DFig. 3EFig. 3FFig. 4Fig. 5Fig. 6Fig. 7Fig. 8Fig. 9 PMID:5902704

  13. 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.

  14. 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

  15. Risk of coronary artery involvement in Kawasaki disease.

    Science.gov (United States)

    Soriano-Ramos, María; Martínez-Del Val, Elena; Negreira Cepeda, Sagrario; González-Tomé, María I; Cedena Romero, Pilar; Fernández-Cooke, Elisa; Albert de la Torre, Leticia; Blázquez-Gamero, Daniel

    2016-04-01

    Kawasaki disease refers to systemic vasculitis with risk of coronary artery disease. Our objective is to identify risk factors associated with coronary artery disease in patients with complete and incomplete Kawasaki disease. Descriptive, retrospective study conducted in patients diagnosed with Kawasaki disease in a tertiary-care hospital between 2008 and 2014. The American Heart Association diagnostic criteria were used to define complete and incomplete Kawasaki disease. Thirty-one children were diagnosed with Kawasaki disease; 24 met the criteria for the complete form, and 7, for the incomplete form of this condition. Five had coronary artery disease. One of them had incomplete Kawasaki disease (1/7= 14.3%), and the remaining four had the complete form (4/24= 16.7%). No significant differences were found between both groups (p= 1.0). Patients with coronary artery involvement had a higher C-reactive protein level (median: 16.2 mg/dL versus 8.4 mg/dL, p= 0.047) and lower albuminemia (median: 3.2 mg/dL versus 3.99 mg/dL, p= 0.002). The risk of coronary artery involvement in incomplete Kawasaki disease is similar to that in complete Kawasaki disease; therefore, in patients with the incomplete form, immunoglobulin therapy should not be delayed. In our population, C-reactive protein and albumin levels were related to a higher risk of coronary artery involvement. Sociedad Argentina de Pediatría.

  16. Cardiac rehabilitation: a good measure to improve quality of life in peri- and postmenopausal women with microvascular angina

    Directory of Open Access Journals (Sweden)

    Wojciech Szot

    2015-05-01

    Full Text Available Cardiac Syndrome X (CSX was considered a stable coronary syndrome, yet due to its nature, CSX symptoms often have a great impact on patients’ Quality of Life (QoL. According to ESC 2013 stable coronary artery disease criteria, CSX was replaced by Microvascular Angina (MA.Unfortunately, most CSX or MA patients, after classical angina (involving main coronary vessels has been ruled out, often do not receive proper treatment. Indications for pharmacological treatment of MA patients were introduced only recently. Another problematic issue is that scientists describing the pathophysiology of both CSX and MA stress a lack of a deeper insight into the multifactorial etiology of the source of pain associated with this disease. In the presented article we have attempted to study the influence of cardiac rehabilitation (3 months programme on the QoL of patients recognized as suffering from MA, as well as to check if changes in myocardial perfusion in these patients at baseline and after completion of cardiac rehabilitation match changes in their QoL. Therefore, after screening 436 women for MA, we studied 55 of them who were confirmed as having MA and who agreed to participate in the study. Exercise tests, Myocardial Perfusion Imaging, and QoL questionnaires were studied at baseline and after completing 3 months period of cardiac rehabilitation. Results were subsequently compared, which showed a link between improved perfusion score in SPECT study and improved overall physical capacity, on one hand, and improved QoL score on the other. These results confirm that cardiac rehabilitation is a very useful treatment option for MA patients. It seems that training during cardiac rehabilitation is a very important factor (improved physical efficiency –> increase in self-belief, and that taking into consideration the multifactor pathophysiology of pain, it is connected with a better quality of life for MA patients.

  17. 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

  18. Quercetin protects human brain microvascular endothelial cells from fibrillar β-amyloid1–40-induced toxicity

    Directory of Open Access Journals (Sweden)

    Yongjie Li

    2015-01-01

    Full Text Available Amyloid beta-peptides (Aβ are known to undergo active transport across the blood-brain barrier, and cerebral amyloid angiopathy has been shown to be a prominent feature in the majority of Alzheimer׳s disease. Quercetin is a natural flavonoid molecule and has been demonstrated to have potent neuroprotective effects, but its protective effect on endothelial cells under Aβ-damaged condition is unclear. In the present study, the protective effects of quercetin on brain microvascular endothelial cells injured by fibrillar Aβ1–40 (fAβ1–40 were observed. The results show that fAβ1–40-induced cytotoxicity in human brain microvascular endothelial cells (hBMECs can be relieved by quercetin treatment. Quercetin increases cell viability, reduces the release of lactate dehydrogenase, and relieves nuclear condensation. Quercetin also alleviates intracellular reactive oxygen species generation and increases superoxide dismutase activity. Moreover, it strengthens the barrier integrity through the preservation of the transendothelial electrical resistance value, the relief of aggravated permeability, and the increase of characteristic enzyme levels after being exposed to fAβ1–40. In conclusion, quercetin protects hBMECs from fAβ1–40-induced toxicity.

  19. Abnormal endothelium-dependent microvascular dilator reactivity in pregnancies complicated by normotensive intrauterine growth restriction

    NARCIS (Netherlands)

    Koopmans, C.M.; Blaauw, Judith; van Pampus, Maria; Rakhorst, G.; Aarnoudse, J.G.

    2009-01-01

    OBJECTIVE: Normotensive intrauterine growth restriction and preeclampsia share a similar placenta pathophysiology, whereas maternal clinical manifestations differ. Clinical symptoms of preeclampsia are partly attributed to vascular endothelial dysfunction, but it is unclear whether this phenomenon p

  20. Association of High-sensitivity C Reactive Protein, Homocysteine with Coronary Lesions and Traditional Cardiovascular Risk Factors in Postmenopausal Women%绝经期后女性同型半胱氨酸、高敏C反应蛋白水平与冠状动脉病变及传统危险因素的关系

    Institute of Scientific and Technical Information of China (English)

    王帅; 赵红丽; 李潞; 张晓丹; 于淼; 李纯; 谭力力

    2013-01-01

    目的:观察绝经期后女性冠心病患者高敏C反应蛋白(hs-CRP)和同型半胱氨酸(Hcy)水平,并分析hs-CRP,Hcy与冠状动脉病变和其他传统危险因素的关系.方法:入选绝经期后女性冠心病患者150例(CHD组),同期选取同年龄段男性冠心病患者150例(男性CHD组)及冠状动脉造影阴性的女性146例(非CHD组)作为对照组,比较3组患者一般资料及hs-CRP,Hcy水平.评价绝经期后女性冠心病患者冠状动脉病变与hs-CRP,Hcy的关系,并进行hs-CRP,Hcy与血脂、血压等传统危险因素相关性分析.结果:绝经期后女性冠心病患者同男性相比患高血压、糖尿病者明显增多;吸烟者较少,肾小球滤过率下降,hs-CRP和Hcy水平增高(P<0.05).绝经期后女性冠心病患者中三支病变者hs-CRP和Hcy水平较单支病变者显著增高(P<0.05);重度病变患者hs-CRP和Hcy水平较轻度病变者增高明显(P<0.05).hs-CRP和Hcy呈正相关(r=0.472,P <0.001);Hcy与体重指数(BMI),收缩压,舒张压呈正相关;hs-CRP与BMI,收缩压呈正相关,与肾小球滤过率(GFR)呈负相关.结论:绝经期后女性冠心病患者hs-CRP及Hcy水平增高,两者呈现正相关,且与血压,肥胖具有相关性.%Objective; To study the contribution of high-sensitivity C reactive protein (hs-CRP) and homocysteine ( Hcy) on coronary lesions and investigate the association of that with traditional cardiovascular risk factors in postmenopausal women. Method; This study involved 150 consecutive postmenopausal women ( CHD female group) with coronary heart disease (CHD), 150 consecutive men with CHD (male group) and 146 postmenopausal women with non-CHD ( non-CHD female group). All patients underwent coronary angiography. The levels of hs-CRP and Hey were detected in three groups. The association of hs-CRP, Hey with coronary lesions and traditional cardiovascular risk factors was analyzed. Result; There were significant difference traditional cardiovascular

  1. ID3 contributes to the acquisition of molecular stem cell-like signature in microvascular endothelial cells: its implication for understanding microvascular diseases.

    Science.gov (United States)

    Das, Jayanta K; Voelkel, Norbert F; Felty, Quentin

    2015-03-01

    While significant progress has been made to advance our knowledge of microvascular lesion formation, yet the investigation of how stem-like cells may contribute to the pathogenesis of microvascular diseases is still in its infancy. We assessed whether the inhibitor of DNA binding and differentiation 3 (ID3) contributes to the acquisition of a molecular stem cell-like signature in microvascular endothelial cells. The effects of stable ID3 overexpression and SU5416 treatment - a chemical inducer of microvascular lesions, had on the stemness signature were determined by flow cytometry, immunoblot, and immunohistochemistry. Continuous ID3 expression produced a molecular stemness signature consisting of CD133(+) VEGFR3(+) CD34(+) cells. Cells exposed to SU5416 showed positive protein expression of ID3, VEGFR3, CD34 and increased expression of pluripotent transcription factors Oct-4 and Sox-2. ID3 overexpressing cells supported the formation of a 3-D microvascular lesion co-cultured with smooth muscle cells. In addition, in vivo microvascular lesions from SuHx rodent model showed an increased expression of ID3, VEGFR3, and Pyk2 similar to SU5416 treated human endothelial cells. Further investigations into how normal and stem-like cells utilize ID3 may open up new avenues for a better understanding of the molecular mechanisms which are underlying the pathological development of microvascular diseases.

  2. Coronary Artery Bypass Surgery

    Science.gov (United States)

    In coronary artery disease (CAD), the arteries that supply blood and oxygen to your heart muscle grow hardened and narrowed. You may try ... these treatments don't help, you may need coronary artery bypass surgery. The surgery creates a new ...

  3. Study of Correlation between Peripheral Blood Mononuclear Cells miR 145 and High sensitivity C reactive Protein in Patients with Acute Coronary Syndrome%急性冠脉综合征患者外周血单核细胞miR145与超敏C反应蛋白的相关性研究

    Institute of Scientific and Technical Information of China (English)

    姜春玲

    2015-01-01

    Objective To investigate correlation between the peripheral blood mononuclear cells miR 145 and high sensitivity C reactive protein in patients with acute coronary syndrome .Methods 90 patients with ACS were randomly selected .30 were diagnosed as unstable angina pectoris (UAP ,group A) ,30 patients were diagnosed as STEMI (group B) and 30 patients were diagnosed as NSTEMI (group C) .Another 30 cases were selected as a control group (group D) hospitalized with chest discomfort ,with no previous history of hyper-tension ,diabetes and coronary heart disease ,and excluding coronary heart disease by the electrocardiogram ,myocardial enzymes and coronary angiography .Using Real time PCR to detect the expression level of miR 145 in PBMCs ,while using U 6 as an internal refer-ence control .Hs CRP levels were detected by ELISA .Results group A ,group B ,C were compared with group D respectively ,expres-sion level of peripheral blood mononuclear cells miR 145in patients with acute coronary syndrome was significantly lower (P< 0 .05) ;levels of hs CRP of supernatant cytokine cultured in PBMCs were significantly elevated (P< 0 .05) ;pearson correlation analysis showed that expression levels of peripheral blood mononuclear cellsmiR 145 and hs CRP were correlated negatively inpatients with ACS (r =0.84 , P< 0.05) .Conclusions Peripheral blood mononuclear cellsmiR 145and hs CRP were correlated negatively in patients with acute coronary syndrome ,that may become a new biomarker for acute coronary syndrome .%目的:探讨急性冠脉综合征(ACS)患者外周血单核细胞(PBMCs)miR 145与超敏 C 反应蛋白的相关性。方法选取急性冠脉综合征患者90例,其中不稳定型心绞痛(UAP)30例(A 组),ST 段抬高型心肌梗死(STEMI)30例(B 组)和非 ST 段抬高型心肌梗死(NSTEMI)30例(C 组)。另外30例以心前区不适住院,既往无高血压、糖尿病和冠心病史,经心电图、心肌酶学和冠状动脉

  4. Correlative analysis of serum high sensitivity C-reactive protein and white blood cell count with coronary lesion and risk factors%白细胞计数和血清高敏C-反应蛋白与冠状动脉病变及危险因素相关性分析

    Institute of Scientific and Technical Information of China (English)

    冯姗

    2012-01-01

    Objective To investigate the relationship of high-sensitivity C-reactive protein (hsCRP) and white blood cell count (WBC) with extent of coronary lesion and if it is an independent risk factor for coronary heart disease (CHD).Methods One hundred and twelve patients with CHD confirmed by angiography and 35 patients without CHD (excluded by coronarography).All patients measuring WBC,serum hs-CRP,serum high density lipoprotein (HDL-C),low density lipoprotein (LDL-C),and 2 h postprandial blood glucose levels by automated hematology analyzer (AHA) and latex immune enhancement act.According to the results of coronary angiography,CHD group was divided into 1,2,3 lesions,observed the relationship between WBC and hs-CRP with coronary artery lesions.Also investigated age,gender,body mass index (BMI),blood pressure,smoking.Results There were significantlydifference (P < 0.01) between two groups in WBC,serum of hs-CRP,HDL-C,LDL-C,postprandial 2 h blood glucose levels.With the increase in the number of coronary arteries,the WBC count,serum hs-CRP levels gradually increased.White blood cell count and body mass index,waist circumference,blood pressure,HDL-C and LDL-C,2-hour postprandial blood glucose were positively correlated (P < 0.01),they were negatively correlated with high density lipoprotein (P =0.000).White blood cell count and severity of coronary lesions were positively correlated (r =0.400,P =0.000).The level of white blood cell count as the dependent variable multiple regression analysis showed that the only variable,BMI,of hs-CRP,smoking into the regression equation.Conclusions Inflammatory response may be involved in the occurrence of coronary artery disease,white blood cell count levels are related with cardiovascular disease risk factors such as obesity,2 h postprandial blood glucose,blood pressure,LDL and smoking.%目的 探讨白细胞计数(WBC)和超敏C-反应蛋白(hs-CRP)与冠状动脉病变程度的关系及是否是冠心病(CHD

  5. 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.

  6. Exercised-Induced Coronary Spasm in Near Normal Coronary Arteries

    Directory of Open Access Journals (Sweden)

    Damian Franzen

    2010-01-01

    Full Text Available In contrast to effort-induced symptoms in obstructive coronary disease, spasm in normal coronary arteries is characterized by angina at rest. We describe a 44-year-old patient with minor coronary plaques and pure exercised-induced coronary spasm. The case questions the differential pathogenic considerations of variant of the variant as opposed to Prinzmetal's variant angina.

  7. Kallistatin as a marker of microvascular complications in children and adolescents with type 1 diabetes mellitus: Relation to carotid intima media thickness.

    Science.gov (United States)

    El-Asrar, Mohamed A; Andrawes, Nevine G; Ismail, Eman A; Salem, Shaimaa Mh

    2015-12-01

    In diabetes, angiogenesis is disturbed, contributing to proliferative retinopathy, nephropathy and neuropathy. Kallistatin, a serine proteinase inhibitor, has anti-angiogenic effects. We assessed serum kallistatin in children and adolescents with type 1 diabetes as a potential marker for microvascular complications and its relation to carotid intima media thickness (CIMT). Sixty patients with type 1 diabetes were divided into two groups according to the presence of microvascular complications and compared with 30 healthy controls. High-sensitivity C-reactive protein (hs-CRP), HbA1c, urinary albumin creatinine ratio (UACR), kallistatin levels and CIMT were assessed. Kallistatin levels were significantly higher in patients with microvascular complications (9.9 ± 2.38 ng/mL) and those without complications (5.0 ± 1.5 ng/mL) than in healthy controls (1.39 ± 0.55 ng/mL; pgroup (pblood glucose, HbA1c, triglycerides, total cholesterol, hs-CRP, UACR and CIMT (pdiabetes and its relation with CIMT may reflect vascular dysfunction and suggest a link between micro- and macro-angiopathy.

  8. Coronary atherosclerosis in sudden cardiac death: An autopsy study

    Directory of Open Access Journals (Sweden)

    Sudha M

    2009-10-01

    Full Text Available Background: The incidence of ischemic heart disease (IHD has markedly increased in India over the past few years. Considering the variations in racial, dietary and lifestyle patterns in our population, it is essential to study the biology of coronary atherosclerosis in our patients. Vulnerable plaques have a large number of foam cells, extracellular lipid, thin fibrous caps and clusters of inflammatory cells and are more prone to rupture. These plaques are nourished by the microvessels arising from the vasa vasorum of the blood vessels and by lumen-derived microvessels through the fibrous cap. This autopsy study was designed to analyse the coronary arterial tree in cases of sudden cardiac death, classify coronary atherosclerotic plaques and to assess the factors contributing to vulnerability of the plaques including inflammation, calcification and microvascular density. Materials and Methods: Seven cases of sudden cardiac death were included in the study. The hearts were perfusion-fixed and the coronary arteries along with their main branches were dissected and studied. The location of the plaques, type of plaques, presence of inflammation and calcification were assessed. The cap thickness and microvessel density per 1000um 2 were assessed. The statistical significance was estimated. Results and Conclusions: Extensive high-grade coronary atherosclerotic disease was seen in all sudden cardiac death cases. Majority of the plaques were vulnerable. High-grade inflammation was seen in most of the vulnerable and ruptured plaques. All the ruptured plaques were uncalcified indicating that calcification probably stabilizes the plaques and protects against rupture. Increased microvessel density was noted in ruptured plaques compared to vulnerable plaques. However, it was not statistically significant.

  9. Environmental Stress and Biobehavioral Antecedents of Coronary Heart Disease.

    Science.gov (United States)

    Krantz, David S.; And Others

    1988-01-01

    Provides an overview of research on the biobehavioral antecedents of coronary heart disease, including stressful occupational settings characterized by high demands and little control over the job, and the Type A pattern, particularly hostility and mode of anger expression (anger-in). Discusses research on physiologic responsiveness (reactivity)…

  10. Physiological basis and long-term clinical outcome of discordance between fractional flow reserve and coronary flow velocity reserve in coronary stenoses of intermediate severity.

    Science.gov (United States)

    van de Hoef, Tim P; van Lavieren, Martijn A; Damman, Peter; Delewi, Ronak; Piek, Martijn A; Chamuleau, Steven A J; Voskuil, Michiel; Henriques, José P S; Koch, Karel T; de Winter, Robbert J; Spaan, Jos A E; Siebes, Maria; Tijssen, Jan G P; Meuwissen, Martijn; Piek, Jan J

    2014-06-01

    Discordance between fractional flow reserve (FFR) and coronary flow velocity reserve (CFVR) may reflect important coronary pathophysiology but usually remains unnoticed in clinical practice. We evaluated the physiological basis and clinical outcome associated with FFR/CFVR discordance. We studied 157 intermediate coronary stenoses in 157 patients, evaluated by FFR and CFVR between April 1997 and September 2006 in which revascularization was deferred. Long-term follow-up was performed to document the occurrence of major adverse cardiac events: cardiac death, myocardial infarction, or target vessel revascularization. Discordance between FFR and CFVR occurred in 31% and 37% of stenoses at the 0.75, and 0.80 FFR cut-off value, respectively, and was characterized by microvascular resistances during basal and hyperemic conditions. Follow-up duration amounted to 11.7 years (Q1-Q3, 9.9-13.3 years). Compared with concordant normal results of FFR and CFVR, a normal FFR with an abnormal CFVR was associated with significantly increased major adverse cardiac events rate throughout 10 years of follow-up, regardless of the FFR cut-off applied. In contrast, an abnormal FFR with a normal CFVR was associated with equivalent clinical outcome compared with concordant normal results: ≤ 3 years when FFR requirement of intracoronary flow assessment in addition to coronary pressure for optimal risk stratification in stable coronary artery disease. © 2014 American Heart Association, Inc.

  11. Exercise training restores coronary arteriolar dilation to NOS activation distal to coronary artery occlusion - Role of hydrogen peroxide

    NARCIS (Netherlands)

    Thengchaisri, Naris; Shipley, Robert; Ren, Yi; Parker, Janet; Kuo, Lih

    2007-01-01

    Objective - Exercise training has been shown to restore vasodilation to nitric oxide synthase (NOS) activation in arterioles distal to coronary artery occlusion. Because reactive oxygen species are generated during NOS uncoupling and the production of vasodilator H2O2 is increased during exercise in

  12. Ectopic Origin of Coronary Arteries Diagnozed by Coronary Angiography

    Science.gov (United States)

    Krasniqi, Xhevdet; Gorani, Daut; Sejdiu, Basri; Citaku, Hajdin

    2016-01-01

    Introduction: Anomalous origin of coronary arteries from opposite sinus of Valsalva is rare finding. The incidence of anomalous origination of the left coronary artery from right sinus is 0.15% and the right coronary artery from the left sinus is 0.92%. The ectopic origin of left coronary artery or right coronary artery from opposite sinus depending on pathways and considering atherosclerotic changes are manifested with different clinical significance. Case report: We report two cases, the first case the coronary angiography showed the left coronary artery arising from the right coronary sinus, presenting with proximally and distally stenosed left anterior descending artery (LAD), associated with medial and distal stenosed right coronary artery (RCA). The second case the coronary angiography revealed the right coronary artery arising from the left coronary sinus, associated with tortuous medial and distal segments of left anterior descending artery (LAD), without atherosclerotic changes. The first case successfully underwent treatment procedures based on guidelines for revascularization. Conclusion: The coronary angiography of patients with coronary ischemia determines atherosclerotic disease with possibility of the presence of coronary artery anomalies that in cases with ectopic origin from opposite sinus continues to exist as a challenge during treatment in interventional cardiology. PMID:27482140

  13. 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

  14. Vitamin D levels and microvascular complications in type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Sarita Bajaj

    2014-01-01

    Full Text Available Background: Vitamin D has important actions on glucose metabolism. These include improved insulin exocytosis, direct stimulation of insulin receptor, improved uptake of glucose by peripheral tissues, improving insulin resistance. It has got various pleiotropic effects like suppression of cell mediated immunity, regulation of cell proliferation, stimulation of neurotropic factors such as nerve growth factor, Glial cell line-derived neurotrophic factor, neurotropin, suppression of RAAS, reduction of albuminuria, immunomodulatory effects, and anti-inflammatory effects. Thus, vitamin D is implicated in many ways in the pathogenesis of retinopathy, neuropathy and nephropathy. Objectives: To study the correlation of vitamin D levels with microvascular complications in type 2 diabetes. Materials and Methods: Cross-sectional case-control study of 18 patients (18-70 years, who met the American Diabetes Association 2011 criteria for type 2 diabetes, was conducted. Age and sex matched healthy controls were taken. Subjects were evaluated for the presence of microvascular complications by clinical evaluation, urine examination, fundus examination, nerve conduction studies, and various biochemical tests. 25-OH cholecalciferol levels were done for each. Cut off level for vitamin D deficiency was 20 ng/ml. Results: Mean vitamin D was lower in type 2 diabetics than healthy subjects (19.046 vs. 27.186 ng/ml. Prevalence of vitamin D deficiency and insufficiency was found to significantly higher in diabetics when compared to healthy subjects (P = 0.0001. Vitamin D deficiency was found to be significantly associated with neuropathy (χ2 = 5.39, df = 1, P = 0.020, retinopathy, (χ2 = 6.6, df = 1, P = 0.010 and nephropathy (χ2 = 10. 52, df = 1, P = 0.001. Lower levels of vitamin D were found to be associated with increasing prevalence of combinations of microvascular complications namely neuropathy with retinopathy (P = 0.036, neuropathy with nephropathy (P = 0

  15. 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.

  16. Alternative venous outflow vessels in microvascular breast reconstruction.

    Science.gov (United States)

    Mehrara, Babak J; Santoro, Timothy; Smith, Andrew; Arcilla, Eric A; Watson, James P; Shaw, William W; Da Lio, Andrew L

    2003-08-01

    The lack of adequate recipient vessels often complicates microvascular breast reconstruction in patients who have previously undergone mastectomy and irradiation. In addition, significant size mismatch, particularly in the outflow veins, is an important contributor to vessel thrombosis and flap failure. The purpose of this study was to review the authors' experience with alternative venous outflow vessels for microvascular breast reconstruction. In a retrospective analysis of 1278 microvascular breast reconstructions performed over a 10-year period, the authors identified all patients in whom the external jugular or cephalic veins were used as the outflow vessels. Patient demographics, flap choice, the reasons for the use of alternative venous drainage vessels, and the incidence of microsurgical complications were analyzed. The external jugular was used in 23 flaps performed in procedures with 22 patients. The superior gluteal and transverse rectus abdominis musculocutaneous (TRAM) flaps were used in the majority of the cases in which the external jugular vein was used (72 percent gluteal, 20 percent TRAM flap). The need for alternative venous outflow vessels was usually due to a significant vessel size mismatch between the superior gluteal and internal mammary veins (74 percent). For three of the external jugular vein flaps (13 percent), the vein was used for salvage after the primary draining vein thrombosed, and two of three flaps in these cases were eventually salvaged. In three patients, the external jugular vein thrombosed, resulting in two flap losses, while the third was salvaged using the cephalic vein. A total of two flaps were lost in the external jugular vein group. The cephalic vein was used in 11 flaps (TRAM, 64.3 percent; superior gluteal, 35.7 percent) performed in 11 patients. In five patients (54.5 percent), the cephalic vein was used to salvage a flap after the primary draining vein thrombosed; the procedure was successful in four cases. In three

  17. Signal Intensity of Superb Microvascular Imaging Correlates with the Severity of Acute Cholecystitis

    Directory of Open Access Journals (Sweden)

    Minoru Tomizawa

    2016-08-01

    Full Text Available Evaluation of the severity of acute cholecystitis is critical for the management of this condition. Superb microvascular imaging (SMI enables the assessment of slow blood flow of small vessels without any contrast medium. An 84-year-old man visited our hospital with right upper abdominal pain. Computed tomography and abdominal ultrasonography showed a slight thickening of the gallbladder. White blood cell count and C-reactive protein levels were elevated. He was diagnosed with acute cholecystitis and treated conservatively with antibiotics. Two days later, his condition worsened and percutaneous transhepatic gallbladder drainage (PTGBD was performed. The patient recovered and was discharged, and his drainage was withdrawn 7 days later. On admission, color-coded SMI (cSMI showed pulsatory signals on the slightly thickened gallbladder wall. On the day of PTGBD, the intensity of the signal on cSMI had increased. Once the patient was cured, no further signal was observed on the gallbladder wall with either cSMI or mSMI. In conclusion, the strong pulsatory signal correlated with the severity of acute cholecystitis observed with cSMI and mSMI. Illustrating the signal intensity is useful for the evaluation of the severity of acute cholecystitis.

  18. Signal Intensity of Superb Microvascular Imaging Correlates with the Severity of Acute Cholecystitis

    Science.gov (United States)

    Tomizawa, Minoru; Shinozaki, Fuminobu; Motoyoshi, Yasufumi; Sugiyama, Takao; Yamamoto, Shigenori; Ishige, Naoki

    2016-01-01

    Evaluation of the severity of acute cholecystitis is critical for the management of this condition. Superb microvascular imaging (SMI) enables the assessment of slow blood flow of small vessels without any contrast medium. An 84-year-old man visited our hospital with right upper abdominal pain. Computed tomography and abdominal ultrasonography showed a slight thickening of the gallbladder. White blood cell count and C-reactive protein levels were elevated. He was diagnosed with acute cholecystitis and treated conservatively with antibiotics. Two days later, his condition worsened and percutaneous transhepatic gallbladder drainage (PTGBD) was performed. The patient recovered and was discharged, and his drainage was withdrawn 7 days later. On admission, color-coded SMI (cSMI) showed pulsatory signals on the slightly thickened gallbladder wall. On the day of PTGBD, the intensity of the signal on cSMI had increased. Once the patient was cured, no further signal was observed on the gallbladder wall with either cSMI or mSMI. In conclusion, the strong pulsatory signal correlated with the severity of acute cholecystitis observed with cSMI and mSMI. Illustrating the signal intensity is useful for the evaluation of the severity of acute cholecystitis. PMID:27721732

  19. Fermented Chinese Formula Shuan-Tong-Ling Protects Brain Microvascular Endothelial Cells against Oxidative Stress Injury

    Directory of Open Access Journals (Sweden)

    Lingjing Tan

    2016-01-01

    Full Text Available Fermented Chinese formula Shuan-Tong-Ling (STL, composed of fourteen medicinal herbs, was an experiential formula by Dr. Zhigang Mei for treating vascular encephalopathy, but the underlying mechanisms remained unknown. In this study, we aimed to investigate the protective effects of fermented STL on hydrogen peroxide- (H2O2- induced injury in rat brain microvascular endothelial cells (BMECs and the possible mechanisms. Cultured BMECs were treated with H2O2, STL, or nicotinamide (NAM, a SIRT1 inhibitor. Then, 3-(4,5-dimethylthiazol-2-yl-2,5-diphenyl-2H-tetrazolium bromide (MTT assay was employed to detect cell proliferation and senescence-associated beta-galactosidase (SA-β-gal was used to examine cell senescence. Cell nuclei were observed by 4′,6-diamidino-2-phenylindole. Additionally, changes in reactive oxygen species (ROS, superoxide dismutase (SOD, and glutathione (GSH levels were measured. Expression of SIRT1, p21, and PGC-1α was determined by western blot. Cell proliferation significantly increased with STL treatment in a dose-dependent manner. H2O2 treatment could intensify cell senescence and nuclei splitting or pyknosis. With STL treatment, the reduced ROS level was accompanied by increased SOD and GSH activity. Further assays showed upregulation of SIRT1 and PGC-1α and downregulation of p21 after STL treatment. The results revealed that STL could protect BMECs against oxidative stress injury at least partially through the SIRT1 pathway.

  20. Melatonin reduces microvascular damage and insulin resistance in hamsters due to chronic intermittent hypoxia.

    Science.gov (United States)

    Bertuglia, Silvia; Reiter, Russel J

    2009-04-01

    Obstructive sleep apnea (OSA) causes intermittent hypoxia (IH) associated with hypertension, insulin resistance and a systemic inflammatory response. We evaluated the effects of melatonin on vasodilation, capillary perfusion in hamster cheek pouch and insulin resistance, hypertension, and reactive oxygen species (ROS) and nitrate/nitrite levels after IH for 4 wk. Syrian hamsters were divided into four groups: control group (CON), IH group, and melatonin (10 mg/kg) intraperitoneally administered daily for 4 wk/30 min before intermittent air (MEL) or IH (IH + MEL) exposure. IH alone caused elevated blood pressure, increased hematocrit, fasting hyperglycemia, elevated ROS and nitrite/nitrate levels, and vasoconstriction and reduced microvascular perfusion. Melatonin treatment of IH-exposed animals decreased blood pressure, blood glucose, and ROS and nitrite/nitrate levels, and increased vasodilation and capillary perfusion. An oral glucose tolerance test was performed after 4 wk of IH. During the last 30 min of the hyperinsulinemic euglycemic clamp, blood glucose, and insulin levels were identically matched between groups, but the glucose infusion rate was significantly reduced in IH (29.9 +/- 1.9 mg/kg/min) versus IH + MEL group (45.4 +/- 1.5 mg/kg/min, P melatonin. In conclusion, protection induced by melatonin against functional and metabolic impairment in IH is related to the regulation of ROS and nitrite/nitrate levels in the microcirculation. These observations may have importance to OSA pathological changes.

  1. Coronary Artery Disease - Coronary Heart Disease

    Science.gov (United States)

    ... result of coronary artery disease, or CAD, said Edward A. Fisher, M.D., Ph.D., M.P. ... Problems and Disease • High Blood Pressure (HBP) • Metabolic Syndrome • Pericarditis • Peripheral Artery Disease (PAD) • Stroke • Vascular Health • ...

  2. The acute effects of exercise on the microvascular volume of Achilles tendons in healthy young subjects

    DEFF Research Database (Denmark)

    Pingel, Jessica; Harrison, Adrian; Suetta, Charlotte

    2013-01-01

    Real-time harmonic contrast-enhanced ultrasound (CEU) is used in several diseases to visualize the microvascularization in various tissues, due to its high sensitivity.......Real-time harmonic contrast-enhanced ultrasound (CEU) is used in several diseases to visualize the microvascularization in various tissues, due to its high sensitivity....

  3. Tumor necrosis factor-alpha increases myocardial microvascular transport in vivo

    DEFF Research Database (Denmark)

    Hansen, P R; Svendsen, Jesper Hastrup; Høyer, S

    1994-01-01

    ng/kg for 60 min) on myocardial microvascular transport of a small hydrophilic indicator was examined by the single-injection, residue-detection method. Intracoronary infusion of rTNF-alpha increased myocardial microvascular transport after 120 min. This increase was preceded by a sustained decline...

  4. 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

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

    Science.gov (United States)

    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.

  6. Comparison of Lipoprotein-Associated Phospholipase A2 and High Sensitive C-Reactive Protein as Determinants of Metabolic Syndrome in Subjects without Coronary Heart Disease: In Search of the Best Predictor

    Directory of Open Access Journals (Sweden)

    Mónica Acevedo

    2015-01-01

    Full Text Available High sensitivity C-reactive protein (hsCRP is a marker of metabolic syndrome (MS and cardiovascular (CV disease. Lipoprotein-associated phospholipase A2 (Lp-PLA2 also predicts CV disease. There are no reports comparing these markers as predictors of MS. Methods. Cross-sectional study comparing Lp-PLA2 and hsCRP as predictors of MS in asymptomatic subjects was carried out; 152 subjects without known atherosclerosis participated. Data were collected on demographics, cardiovascular risk factors, anthropometric and biochemical measurements, and hsCRP and Lp-PLA2 activity levels. A logistic regression analysis was performed with each biomarker and receiver operating characteristic (ROC curves were constructed for MS. Results. Mean age was 46 ± 11 years, and 38% of the subjects had MS. Mean Lp-PLA2 activity was 185 ± 48 nmol/mL/min, and mean hsCRP was 2.1 ± 2.2 mg/L. Subjects with MS had significantly higher levels of Lp-PLA2 (P=0.03 and hsCRP (P<0.0001 than those without MS. ROC curves showed that both markers predicted MS. Conclusion. Lp-PLA2 and hsCRP are elevated in subjects with MS. Both biomarkers were independent and significant predictors for MS, emphasizing the role of inflammation in MS. Further research is necessary to determine if inflammation predicts a higher risk for CV events in MS subjects.

  7. Comparison of Lipoprotein-Associated Phospholipase A2 and High Sensitive C-Reactive Protein as Determinants of Metabolic Syndrome in Subjects without Coronary Heart Disease: In Search of the Best Predictor

    Science.gov (United States)

    Acevedo, Mónica; Kramer, Verónica; Adasme, Marcela; Briones, Luisa

    2015-01-01

    High sensitivity C-reactive protein (hsCRP) is a marker of metabolic syndrome (MS) and cardiovascular (CV) disease. Lipoprotein-associated phospholipase A2 (Lp-PLA2) also predicts CV disease. There are no reports comparing these markers as predictors of MS. Methods. Cross-sectional study comparing Lp-PLA2 and hsCRP as predictors of MS in asymptomatic subjects was carried out; 152 subjects without known atherosclerosis participated. Data were collected on demographics, cardiovascular risk factors, anthropometric and biochemical measurements, and hsCRP and Lp-PLA2 activity levels. A logistic regression analysis was performed with each biomarker and receiver operating characteristic (ROC) curves were constructed for MS. Results. Mean age was 46 ± 11 years, and 38% of the subjects had MS. Mean Lp-PLA2 activity was 185 ± 48 nmol/mL/min, and mean hsCRP was 2.1 ± 2.2 mg/L. Subjects with MS had significantly higher levels of Lp-PLA2 (P = 0.03) and hsCRP (P < 0.0001) than those without MS. ROC curves showed that both markers predicted MS. Conclusion. Lp-PLA2 and hsCRP are elevated in subjects with MS. Both biomarkers were independent and significant predictors for MS, emphasizing the role of inflammation in MS. Further research is necessary to determine if inflammation predicts a higher risk for CV events in MS subjects. PMID:26089902

  8. Coronary Artery Bypass

    Directory of Open Access Journals (Sweden)

    Kadri Ceberut

    2011-01-01

    Full Text Available Ancient schwannoma is a rare variant of neural tumors though rarely seen in the thorax. The combination with coronary artery diseases is also rare. Here we describe a 66 year-old male who had undergone one-stage combined surgery for thoracic ancient schwannomas removal and coronary artery disease. The masses were, respectively, 13 cm in the middle mediastinum and 5 cm in diameter originating from the intercostal nerve. The tumors were successfully removed using sternotomy, and then a coronary artery bypass grafting was performed. Here we discuss this rare tumor in relation to the relevant literature.

  9. Tailored antiplatelet therapy to improve prognosis in patients exhibiting clopidogrel low-response prior to percutaneous coronary intervention for stable angina or non-ST elevation acute coronary syndrome

    DEFF Research Database (Denmark)

    Paarup Dridi, Nadia; Johansson, Pär I; Lønborg, Jacob T

    2015-01-01

    Abstract Aim: To investigate whether an intensified antiplatelet regimen could improve prognosis in stable or non-ST elevation in acute coronary syndrome (ACS) patients exhibiting high on-treatment platelet reactivity (HTPR) on clopidogrel and treated with percutaneous coronary intervention (PCI...

  10. 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.

  11. Bosentan fosters microvascular de-remodelling in systemic sclerosis.

    Science.gov (United States)

    Guiducci, S; Bellando Randone, S; Bruni, C; Carnesecchi, G; Maresta, A; Iannone, F; Lapadula, G; Matucci Cerinic, M

    2012-12-01

    Bosentan, a dual endothelin receptor antagonist, may reduce blood pressure by blocking the vasoconstrictor effect of endothelin-1. In systemic sclerosis (SSc) nailfold videocapillaroscopy (NVC); allows diagnostic and follow-up of microvascular damage. Distinct NVC patterns have been identified for the evaluation of severity of SSc microvascular damage. The objective of this study is to evaluate the modification of the microvasculature under Bosentan therapy in SSc patients with pulmonary arterial hypertension (PAH). Nine patients with PAH related to SSc in New York Heart Association classes III-IV were treated with Bosentan 125 mg twice a day. NVC optical probe videocapillaroscopy equipped with 100× and 200× contact lenses and connected to image analyse software was performed before and after 12 months of Bosentan therapy to evaluate the modification of microvasculature. Nine PAH SSc patients treated with Iloprost were used as controls. Before Bosentan therapy, seven patients showed at NVC severe loss of capillaries with large avascular areas and vascular architectural disorganisation which are typically "late" SSc pattern. After 12 months of Bosentan, NVC pattern changed in seven patients from "late" into "active" SSc pattern. The disappearance of avascular areas and capillary haemorrhages was the most striking result. Two patients had an "active" SSc pattern, not modified by Bosentan treatment. These data show that Bosentan may improve NVC pattern in SSC and the presence of new capillaries suggests that it may favour angiogenesis. Bosentan may improve and stabilise the microvasculature in long-term treatment modulating the structural modifications detected by NVC.

  12. Microvascular flow estimation by microbubble-assisted Nakagami imaging.

    Science.gov (United States)

    Tsui, Po-Hsiang; Yeh, Chih-Kuang; Chang, Chien-Cheng

    2009-04-01

    The destruction and replenishment of microbubbles has been previously applied to estimating blood flow in the microcirculation. The rate of increase of the time-intensity curve (TIC) due to microbubbles flowing into the region-of-interest (ROI) as measured from the conventional B-mode images reflects the flow velocity. In this study, we monitored microbubble replenishment using a new proposed approach called the time-Nakagami-parameter curve (TNC) obtained from the parametric image based on the Nakagami statistical parameter for quantifying the microvascular flow velocity. The Nakagami parameter is estimated from signal envelope to reflect the backscattered statistics. The feasibility of using the TNC to estimate the microvascular flow was explored by carrying out phantom measurements and in vivo animal experiments. The rates of increase of the TIC and TNC were quantified as the rate constants beta(I) and beta(N) of monoexponential fitted curves, respectively. The experimental results showed that beta(N) behaves similarly to the conventional beta(I) in quantifying the flow velocity. Moreover, the tolerance to the effects of clutter is greater for the TNC than for the TIC, which makes it possible to use beta(N) to differentiate various flow velocities even when the ROI contains nonperfused areas. This finding suggests that the TNC-based technique can be used as a complementary tool for the conventional TIC to improve measurement of blood flow in the microcirculation.

  13. The role of the microvascular tortuosity in tumor transport phenomena.

    Science.gov (United States)

    Penta, R; Ambrosi, D

    2015-01-07

    The role of the microvascular network geometry in transport phenomena in solid tumors and its interplay with the leakage and pressure drop across the vessels is qualitatively and quantitatively discussed. Our starting point is a multiscale homogenization, suggested by the sharp length scale separation that exists between the characteristic vessels and the tumor tissue spatial scales, referred to as the microscale and the macroscale, respectively. The coupling between interstitial and capillary compartment is described by a double Darcy model on the macroscale, whereas the geometric information on the microvascular structure is encoded in the effective hydraulic conductivities, which are numerically computed by solving classical differential problems on the microscale representative cell. Then, microscale information is injected into the macroscopic model, which is analytically solved in a prototypical geometry and compared with previous experimentally validated, phenomenological models. In this way, we are able to capture the role of the standard blood flow determinants in the tumor, such as tumor radius, tissue hydraulic conductivity and vessels permeability, as well as influence of the vascular tortuosity on fluid convection. The results quantitatively confirm that transport of blood (and, as a consequence, of any advected anti-cancer drug) can be dramatically impaired by increasing the geometrical complexity of the microvasculature. Hence, our quantitative analysis supports the argument that geometric regularization of the capillary network improves blood transport and drug delivery in the tumor mass.

  14. Optically measured microvascular blood flow contrast of malignant breast tumors.

    Directory of Open Access Journals (Sweden)

    Regine Choe

    Full Text Available Microvascular blood flow contrast is an important hemodynamic and metabolic parameter with potential to enhance in vivo breast cancer detection and therapy monitoring. Here we report on non-invasive line-scan measurements of malignant breast tumors with a hand-held optical probe in the remission geometry. The probe employs diffuse correlation spectroscopy (DCS, a near-infrared optical method that quantifies deep tissue microvascular blood flow. Tumor-to-normal perfusion ratios are derived from thirty-two human subjects. Mean (95% confidence interval tumor-to-normal ratio using surrounding normal tissue was 2.25 (1.92-2.63; tumor-to-normal ratio using normal tissues at the corresponding tumor location in the contralateral breast was 2.27 (1.94-2.66, and using normal tissue in the contralateral breast was 2.27 (1.90-2.70. Thus, the mean tumor-to-normal ratios were significantly different from unity irrespective of the normal tissue chosen, implying that tumors have significantly higher blood flow than normal tissues. Therefore, the study demonstrates existence of breast cancer contrast in blood flow measured by DCS. The new, optically accessible cancer contrast holds potential for cancer detection and therapy monitoring applications, and it is likely to be especially useful when combined with diffuse optical spectroscopy/tomography.

  15. Monitoring microvascular free flaps with tissue oxygen measurement and PET.

    Science.gov (United States)

    Schrey, Aleksi R; Kinnunen, Ilpo A J; Grénman, Reidar A; Minn, Heikki R I; Aitasalo, Kalle M J

    2008-07-01

    Tissue oxygen measurement and positron emission tomography (PET) were evaluated as methods for predicting ischemia in microvascular free flaps of the head and neck. Ten patients with head and neck squamous cell cancer underwent resection of the tumour followed by microvascular reconstruction with a free flap. Tissue oxygenation of the flap (P(ti)O(2)) was continuously monitored for three postoperative (POP) days and the blood flow of the flap was assessed using oxygen-15 labelled water and PET. In three free flaps a perfusion problem was suspected due to a remarkable drop in P(ti)O(2)-values, due to two anastomosis problems and due to POP turgor. No flap losses occurred. During the blood flow measurements with PET [mean 8.5 mL 100 g(-1) min(-1 )(SD 2.5)], the mean P(ti)O(2) of the flaps [46.8 mmHg (SD 17.0)] appeared to correlate with each other in each patient (pmonitoring system of free flaps. The perfusion-study with PET correlates with P(ti)O(2)-measurement.

  16. Reactive Systems

    DEFF Research Database (Denmark)

    Aceto, Luca; Ingolfsdottir, Anna; Larsen, Kim Guldstrand

    A reactive system comprises networks of computing components, achieving their goals through interaction among themselves and their environment. Thus even relatively small systems may exhibit unexpectedly complex behaviours. As moreover reactive systems are often used in safety critical systems......, the need for mathematically based formal methodology is increasingly important. There are many books that look at particular methodologies for such systems. This book offers a more balanced introduction for graduate students and describes the various approaches, their strengths and weaknesses, and when...... they are best used. Milner's CCS and its operational semantics are introduced, together with the notions of behavioural equivalences based on bisimulation techniques and with recursive extensions of Hennessy-Milner logic. In the second part of the book, the presented theories are extended to take timing issues...

  17. The value of measuring plasma oxidized low-density lipoprotein and serum high sensitivity C-reactive protein in patients with acute coronary syndrome%急性冠脉综合征患者测定血浆氧化低密度脂蛋白和血清高敏C-反应蛋白的价值

    Institute of Scientific and Technical Information of China (English)

    魏艳胜; 张晓

    2008-01-01

    Objective To investigate the value of plasma oxidized low-density lipoprotein(ox-LDL)and serum high sensitivity C-reactive protein(hs-CRP)in patients with acute coronary syndrome(ACS).Methods Plasma ox-LDL and serum hs-CRP levels were measured by enzyme-linked immunosorbent assav in 89 patients,who were divided into 4 groups:acute myocardial infarction,stable angina pectoris,unstable angina pectoris and control.Results The ox-LDL and hs-CRP levels were higher in the acute coronary syndrome patients than in the controls and stable angina peetoris(P<0.0 1).Significant positive corrlelation between ox-LDL and hs - CRP was fbund in patients with coronary artery disease(CAD)(r=0.801,P<0.01).but no eorrelation in the controls(r=0.084,P>0.05).No correlation was found between ox-LDL and Gensini score in the CAD group(r=-0.051,P>0.05).Logistic study revealed Dlasma ox-LDL and serum hs-CRP were positively correlated with ACS.Conclusion Plasma ox-LDL and serum hs-CRP can reflect the severity of atherosclerotic CAD,and have great value in assessing the severity of the lesions and plaque stability in ACS.%目的 探讨血浆氧化低密度脂蛋白(ox-LDL)及血清高敏C-反应蛋白(hs-CRP)水平与急性冠脉综合征(ACS)的关系.方法 根据临床诊断标准,将69名冠心病患者分为急性心肌梗死组、不稳定型心绞痛组和稳定型心绞痛组3组,另选取20例冠脉造影正常者为对照组,采用ELISA法测定患者血浆ox-LDL及血清hs-CRP.结果 急性心肌梗死组和不稳定型心绞痛组血浆ox-LDL及血清hs-CRP水平明显高于稳定性心绞痛和对照组(P<0.01);血浆ox-LDL和血清hs-CRP在对照组无相关性(r=0.084,P>0.05),在冠心病组呈高度正相关(r=0.801,P<0.01);在冠心病组,血浆ox-LDL与Gensini积分无相关性(r=-0.051,P>0.05);Logistic回归分析发现血浆ox-LDL及血清hs-CRP水平与ACS呈正相关.结论 血浆ox-LDL及血清hs-CRP水平不仅反映冠心病患者病变的严重程度,

  18. The size does not matter – The presence of microvascular obstruction but not its extent corresponds to larger infarct size in reperfused STEMI

    Energy Technology Data Exchange (ETDEWEB)

    Małek, Łukasz A., E-mail: lmalek@ikard.pl [Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw (Poland); Śpiewak, Mateusz, E-mail: mspiewak@ikard.pl [Department of Coronary Artery Disease and Structural Heart Diseases, Institute of Cardiology, Warsaw (Poland); Kłopotowski, Mariusz, E-mail: mklopotowski@hotmail.com [Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw (Poland); Miśko, Jolanta, E-mail: jmisko@wp.pl [Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw (Poland); Rużyłło, Witold, E-mail: wruzyllo@ikard.pl [Institute of Cardiology, Warsaw (Poland); Witkowski, Adam, E-mail: witkowski@hbz.pl [Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw (Poland)

    2012-10-15

    Background: Microvascular obstruction (MVO) is a cardiac magnetic resonance (CMR) marker of no-reflow in ST-segment elevation myocardial infarction (STEMI). It remains unresolved whether the infarct size corresponds only to the presence of MVO or also to its extent. Methods: The study included 53 patients with first STEMI (median age 61.5 years, 77% male) treated with percutaneous coronary intervention (PCI) who underwent CMR after median 5 days from PCI. Small MVO was defined as patchy, non-confluent spots of dark areas of absent contrast surrounded by late gadolinium enhancement (LGE). Large MVO was defined as confluent areas of MVO comprising a large amount of the infarct zone. Results: Microvascular obstruction was observed in 32 patients (60%) including 18 patients with small MVO (36%) and 14 patients with large MVO (24%). Patients with MVO were more likely to have TIMI 0/1 grade flow on initial angiogram, higher levels of necrotic markers, larger infarct size, larger left ventricular end-diastolic and end-systolic volume and lower ejection fraction in comparison to patients without MVO. These differences were not observed between patients with large and small MVO. Conclusions: The presence of MVO but not its extent corresponds to larger infarct size in STEMI.

  19. Coronary artery spasm

    Science.gov (United States)

    ... Saunders; 2016:chap 71. Giugliano RP, Cannon CP, Braunwald E. Non-ST elevation acute coronary syndromes In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of ...

  20. Auxetic coronary stent endoprosthesis

    DEFF Research Database (Denmark)

    Amin, Faisal; Ali, Murtaza Najabat; Ansari, Umar;

    2014-01-01

    BACKGROUND: Cardiovascular heart disease is one of the leading health issues in the present era and requires considerable health care resources to prevent it. The present study was focused on the development of a new coronary stent based on novel auxetic geometry which enables the stent to exhibit...... a negative Poisson's ratio. Commercially available coronary stents have isotropic properties, whereas the vascular system of the body shows anisotropic characteristics. This results in a mismatch between anisotropic-isotropic properties of the stent and arterial wall, and this in turn is not favorable...... for mechanical adhesion of the commercially available coronary stents with the arterial wall. It is believed that an auxetic coronary stent with inherent anisotropic mechanical properties and negative Poisson's ratio will have good mechanical adhesion with the arterial wall. METHODS: The auxetic design...

  1. Coronary Artery Disease

    Science.gov (United States)

    Coronary artery disease (CAD) is the most common type of heart disease. It is the leading cause of death ... happens when the arteries that supply blood to heart muscle become hardened and narrowed. This is due ...

  2. Coronary heart disease

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008042 Analysis of coronary artery lesion characteristics and its clinical implications in patients with acute non-ST-segment elevation myocardial infarction. BAI Taizhu(柏太柱), et al. Cardiovasc Dept, Hengyang Centr Hosp & Hengyang Cardiovasc Intervention Center, Hengyang 421001. Chin J Arterioscler 2007;15(10):780-782. Objective To investigate the coronary artery lesion characteristics and its clinical implications in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI).

  3. Coronary heart disease

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008277 Relationship between pulse wave velocity and the NYHA classification of coronary insufficiency.SUN Weiping(孙卫平),et al.Dept Cardiol,Tongji Hosp Tongji Univ,Shanghai 200065.Chin J Intern Med 2008;47(5):382-384.Objective To investigate the relationship between brachial-ankle pulse wave velocity(baPWV)and different stage of cardiac dysfunction.Methods 253 consecutive patients with coronary atherosclerotic heart disease

  4. Large coronary intramural hematomas

    DEFF Research Database (Denmark)

    Antonsen, Lisbeth; Thayssen, Per; Jensen, Lisette Okkels

    2015-01-01

    coronary vessel wall pathology, with poorly understood underlying pathogenic mechanisms. Affected individuals may present with a broad spectrum of symptoms ranging from acute coronary syndromes (ACS) to cardiogenic shock or even sudden cardiac death. The disease entity causes challenges in terms of both......, no randomized, controlled trials exist to guide treatment, and no consensus regarding management is available. Currently, treatment strategies are based on a case-by-case clinical assessment, and experiences described in previous, limited retrospective studies and case reports....

  5. Coronary Fistulas: A Case Series

    Directory of Open Access Journals (Sweden)

    Nada Fennich

    2014-01-01

    Full Text Available Coronary artery fistula is an uncommon finding during angiographic exams. We report a case series of five patients with congenital coronary fistulas. The first patient was 56 years old and had a coronary fistula associated with a partial atrio ventricular defect, the second patient was 54 years old and had two fistulas originating from the right coronary artery with a severe atherosclerotic coronary disease, the third patient was 57 years old with a fistula originating from the circumflex artery associated with a rheumatic mitral stenosis, the fourth patient was 50 years old and had a fistulous communication between the right coronary artery and the right bronchial artery, and the last patient was 12 years old who had bilateral coronary fistulas draining into the right ventricle with an aneurismal dilatation of the coronary arteries. Angiographic aspects of coronary fistulas are various; management is controversial and depends on the presence of symptoms.

  6. Biocompatibility of Coronary Stents

    Directory of Open Access Journals (Sweden)

    Thamarasee M. Jeewandara

    2014-01-01

    Full Text Available Cardiovascular disease is the dominant cause of mortality in developed countries, with coronary artery disease (CAD a predominant contributor. The development of stents to treat CAD was a significant innovation, facilitating effective percutaneous coronary revascularization. Coronary stents have evolved from bare metal compositions, to incorporate advances in pharmacological therapy in what are now known as drug eluting stents (DES. Deployment of a stent overcomes some limitations of balloon angioplasty alone, but provides an acute stimulus for thrombus formation and promotes neointimal hyperplasia. First generation DES effectively reduced in-stent restenosis, but profoundly delay healing and are susceptible to late stent thrombosis, leading to significant clinical complications in the long term. This review characterizes the development of coronary stents, detailing the incremental improvements, which aim to attenuate the major clinical complications of thrombosis and restenosis. Despite these enhancements, coronary stents remain fundamentally incompatible with the vasculature, an issue which has largely gone unaddressed. We highlight the latest modifications and research directions that promise to more holistically design coronary implants that are truly biocompatible.

  7. Coronary Artery Anomalies in Animals

    Directory of Open Access Journals (Sweden)

    Brian A. Scansen

    2017-04-01

    Full Text Available Coronary artery anomalies represent a disease spectrum from incidental to life-threatening. Anomalies of coronary artery origin and course are well-recognized in human medicine, but have received limited attention in veterinary medicine. Coronary artery anomalies are best described in the dog, hamster, and cow though reports also exist in the horse and pig. The most well-known anomaly in veterinary medicine is anomalous coronary artery origin with a prepulmonary course in dogs, which limits treatment of pulmonary valve stenosis. A categorization scheme for coronary artery anomalies in animals is suggested, dividing these anomalies into those of major or minor clinical significance. A review of coronary artery development, anatomy, and reported anomalies in domesticated species is provided and four novel canine examples of anomalous coronary artery origin are described: an English bulldog with single left coronary ostium and a retroaortic right coronary artery; an English bulldog with single right coronary ostium and transseptal left coronary artery; an English bulldog with single right coronary ostium and absent left coronary artery with a prepulmonary paraconal interventricular branch and an interarterial circumflex branch; and a mixed-breed dog with tetralogy of Fallot and anomalous origin of all coronary branches from the brachiocephalic trunk. Coronary arterial fistulae are also described including a coronary cameral fistula in a llama cria and an English bulldog with coronary artery aneurysm and anomalous shunting vessels from the right coronary artery to the pulmonary trunk. These examples are provided with the intent to raise awareness and improve understanding of such defects.

  8. The correlations of coronary artery disease with epicardial adipose tissue, insulin resistance and C-reactive protein in different body mass index patients%不同体质量指数人群冠状动脉病变与心外膜脂肪、胰岛素抵抗和C反应蛋白的关系

    Institute of Scientific and Technical Information of China (English)

    王强; 杭涛; 邹莺; 庄微; 程训民; 张启高; 王璟

    2014-01-01

    目的 研究肥胖及非肥胖人群C反应蛋白(CRP)、胰岛素抵抗(IR)及心外膜脂肪体积(EFV)对冠状动脉粥样硬化程度的影响.方法 入选同期行64排双源CT和经皮冠状动脉造影检查的103例患者,测量患者的身高、体质量、腰围(WC),计算体质量指数(BMI).根据BMI分为肥胖组45例和非肥胖组58例;通过64排双源CT测量EFV,收集空腹血液样本行血生化相关指标等检测.采用Gensini积分量化冠状动脉狭窄的严重程度.分析EFV和CRP及稳态胰岛素评估模型计算胰岛素抵抗指数(HOMA-IR)与Gensini积分之间的关系.结果 肥胖组CRP[(11.0 ±5.8) mg/L]、WC[(96.1±7.0) cm]、EFV[(122.7±43.3) cm3]、BMI[(27.9±2.9) kg/m2]高于非肥胖组CRP[(6.5±3.4)mg/L]、WC[(86.4±7.6)cm]、EFV[(92.9±39.5)cm3]、BMI[(22.4±1.9) kg/m2],两组比较差异有统计学意义(t值分别为2.24、6.74、3.64、11.74,P均<0.05).非肥胖组及肥胖组中CRP与EFV均呈正相关(r值分别为0.404、0.364,P均<0.05),而HOMA-IR仅在肥胖组中与BMI呈正相关(r=0.322,P<0.05).非肥胖人群中Gensini积分与EFV及CRP呈正相关(r值分别为0.358、0.315,P均<0.05),肥胖人群中Gensini积分与EFV、CRP及HOMA-IR呈正相关(r值分别为0.348、0.297、0.384,P均<0.05),经过BMI及WC的校正后,除肥胖组中与CRP的相关性消失外,余相关性均存在.最后以Gensini积分作为因变量进行多重线性回归分析,结果提示EFV和糖尿病为肥胖人群Gensini积分的独立危险因素.结论 在非肥胖及肥胖人群中,冠状动脉粥样硬化病变程度与EFV及CRP呈正相关,而在肥胖组中冠状动脉病变程度还受其他体脂分布(BMI、WC)及胰岛素抵抗水平的影响.EFV可作为影响冠状动脉粥样硬化病变程度的独立危险因素.%Objective To evaluate the influence of C-reactive protein (CRP),insulin resistance (IR) and epicardial fat volume (EFV) on the extent of coronary atherosclerosis in patients with different

  9. Coronary Artery Imaging in Children

    Science.gov (United States)

    2015-01-01

    Coronary artery problems in children usually have a significant impact on both short-term and long-term outcomes. Early and accurate diagnosis, therefore, is crucial but technically challenging due to the small size of the coronary artery, high heart rates, and limited cooperation of children. Coronary artery visibility on CT and MRI in children is considerably improved with recent technical advancements. Consequently, CT and MRI are increasingly used for evaluating various congenital and acquired coronary artery abnormalities in children, such as coronary artery anomalies, aberrant coronary artery anatomy specific to congenital heart disease, Kawasaki disease, Williams syndrome, and cardiac allograft vasculopathy. PMID:25741188

  10. Distal coronary hemoperfusion during percutaneous transluminal coronary angioplasty

    NARCIS (Netherlands)

    deMuinck, ED; denHeijer, P; vanDijk, RB; Crijns, HJGM; Hillige, HL; Lie, KI

    1996-01-01

    Distal coronary hemoperfusion during percutaneous transluminal coronary angioplasty (PTCA)-with an autoperfusion balloon or active system-facilitates prolonged balloon inflation. Prolonged inflations may tack up intimal dissections and improve the primary angioplasty result in complex lesions. Addit

  11. Directed assembly of three-dimensional microvascular networks

    Science.gov (United States)

    Therriault, Daniel

    Three-dimensional (3-D) microvascular networks with pervasive, interconnected channels less than 300 mum in diameter may find widespread application in microfluidic devices, biotechnology, sensors, and autonomic healing materials. Although microchannel arrays are readily constructed in two-dimensions by photolithographic or soft lithographic techniques, their construction in three-dimensions remains a challenging problem. The development of a microfabrication method to build 3-D microvascular networks based on direct-write assembly is described is this thesis. The method is based on the robotic deposition of a fugitive organic ink to form a free-standing scaffold structure. Secondary infiltration of a structural resin followed by setting of the matrix and removal of the scaffold yields an embedded pervasive network of smooth cylindrical channels (˜10--500 mum) with defined connectivity. Rheological and other material properties studies of fugitive organic ink were performed in order to identify the critical characteristics required for successful deposition of 3-D scaffolds by direct-write assembly. Guided by the results of these studies, several new ink formulations were screened for improved deposition performance. The most successful of these inks (40wt% microcrystalline wax, 60wt% petroleum jelly) showed excellent deposition and had an equilibrium modulus at room temperature (G 'eq ˜ 7.70 kPa 1 Hz) nearly two orders of magnitude higher than the original ink. The optimized ink was used to successfully build thick (i.e., ˜100 layers) scaffold structures at room temperature with negligible time-dependent deformation post-deposition. Secondary infiltration of the resin was accomplished at room temperature while maintaining the scaffold architecture. The optimized ink was also successfully extruded through small micronozzles (1 mum). The construction of 3-D microvascular networks enables microfluidic devices with unparallel geometric complexity. In one example, a

  12. 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

  13. What Is Reactive Arthritis?

    Science.gov (United States)

    ... Arthritis PDF Version Size: 69 KB November 2014 What is Reactive Arthritis? Fast Facts: An Easy-to- ... Information About Reactive Arthritis and Other Related Conditions What Causes Reactive Arthritis? Sometimes, reactive arthritis is set ...

  14. ST-Segment Elevation Myocardial Infarction and Normal Coronary Arteries after Consuming Energy Drinks.

    Science.gov (United States)

    Gharacholou, S Michael; Ijioma, Nkechinyere; Banwart, Emma; Munoz, Freddy Del Carpio

    2017-01-01

    The use of energy drinks, which often contain stimulants, is common among young persons, yet there have been few reports of adverse cardiac events. We report the case of a 27-year-old man who was admitted to our facility with an acute ST-segment elevation myocardial infarction in the setting of using energy drinks. Angiography revealed no obstructive coronary disease. The patient had elevation of cardiac troponin. Noninvasive testing with echocardiography and cardiac magnetic resonance imaging demonstrated both abnormalities in resting wall motion at the anterior apex along with late gadolinium enhancement of the anterior wall, respectively. The patient also underwent formal invasive evaluation with an intracoronary Doppler study demonstrating normal coronary flow reserve and acetylcholine provocation that excluded endothelial dysfunction and microvascular disease. The patient recovered and has abstained from consuming additional energy drinks with no reoccurrence of symptoms. A review of some of the potential cardiac risks associated with consuming energy drinks is presented.

  15. Reliability of near-infrared angiography and micro-Doppler sonography for evaluating microvascular anastomoses.

    Science.gov (United States)

    Mücke, Thomas; Wolff, Klaus-Dietrich; Wagenpfeil, Stefan; Hölzle, Frank; Scholz, Martin

    2010-11-01

    Intraoperative fluorescence angiography has been reported to be a promising method, with rapid and high-quality image production at low cost when used for the detection of microvascular complications. The purpose of this study was to evaluate the reliability of intraoperative near-infrared indocyanine green angiography compared with microvascular Doppler testing in a standardized model in the rat with different vessel patencies. The carotid, aorta, and femoral vessels of 23 Wistar rats were used. Indocyanine green angiography and microvascular Doppler sonographic testing were performed to assess microanastomosis with a vessel patency randomly narrowed at the anastomosis to an outer patency of 100, 75, 50, 25, and 0 percent. A total of 424 investigations were performed for 68 anastomoses, including both indocyanine green videoangiographic and microvascular Doppler sonographic examinations. The overall sensitivity and specificity of the microvascular Doppler sonographic testing at different degrees of stenoses were 100 and 86.9 percent, respectively. The positive predictive value for all observations was 95.8 percent, and the corresponding negative predictive value was 100 percent. Indocyanine green angiography revealed an overall sensitivity of 95.3 percent and a specificity of 100 percent. The positive predictive value for these observations was 100 percent, and the negative predictive value was 84 percent. Indocyanine green angiography and microvascular Doppler sonography are quick and reliable methods for assessing blood flow in vessels in the laboratory model. The combined use of indocyanine green angiography and microvascular Doppler sonography can increase the accuracy of assessment of microvascular anastomoses intraoperatively. Indocyanine green can be used first, but followed by the microvascular Doppler in cases of a negative result to maximize accuracy.

  16. 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.

  17. Dual anterior descending coronary artery associated with coronary artery disease

    Directory of Open Access Journals (Sweden)

    Siqueira Luciane da L. V.

    2003-01-01

    Full Text Available The patient is a male with risk factors for coronary artery disease, who was referred for cardiac catheterization after acute myocardial infarction in the inferior wall. The patient underwent transluminal coronary angioplasty in the right coronary artery with successful stent implantation.

  18. Distal coronary hemoperfusion during percutaneous transluminal coronary angioplasty

    NARCIS (Netherlands)

    Muinck, Ebo Derk de

    1994-01-01

    In this thesis several aspects of passive and active coronary perfusion during coronary angioplasty are investigated. The autoperfusion balloon catheters that were evaluated are the Stack® and the RX-60® catheters (Advanced Cardiovascular Systems, inc., Santa Clara, California, U.S.A). The coronary

  19. Distal coronary hemoperfusion during percutaneous transluminal coronary angioplasty

    NARCIS (Netherlands)

    Muinck, Ebo Derk de

    1994-01-01

    In this thesis several aspects of passive and active coronary perfusion during coronary angioplasty are investigated. The autoperfusion balloon catheters that were evaluated are the Stack® and the RX-60® catheters (Advanced Cardiovascular Systems, inc., Santa Clara, California, U.S.A). The coronary

  20. Intra-operative neurophysiology during microvascular decompression for hemifacial spasm.

    Science.gov (United States)

    Fernández-Conejero, I; Ulkatan, S; Sen, C; Deletis, V

    2012-01-01

    There is evidence that primary hemifacial spasm (HFS) in the majority of patients is related to a vascular compression of the facial nerve at its root exit zone (REZ). As a consequence, the hyperexcitability of facial nerve generates spasms of the facial muscles. Microvascular decompression (MVD) of the facial nerve near its REZ has been established as an effective treatment of HFS. Intra-operative disappearance of abnormal muscle responses (lateral spread) elicited by stimulating one of the facial nerve branches has been used as a method to predict MVD effectiveness. Other neurophysiologic techniques, such as facial F-wave, blink reflex and facial corticobulbar motor evoked potentials (FCoMEP), are feasible to intra-operatively study changes in excitability of the facial nerve and its nucleus during MVDs. Intra-operative neuromonitoring with the mentioned techniques allows a better understanding of HFS pathophysiology and helps to optimise the MVD.

  1. Holographic laser Doppler imaging of microvascular blood flow

    CERN Document Server

    Magnain, C; Boucneau, T; Simonutti, M; Ferezou, I; Rancillac, A; Vitalis, T; Sahel, J A; Paques, M; Atlan, M

    2014-01-01

    We report on local superficial blood flow monitoring in biological tissue from laser Doppler holographic imaging. In time averaging recording conditions, holography acts as a narrowband bandpass filter, which, combined with a frequency shifted reference beam, permits frequency selective imaging in the radiofrequency range. These Doppler images are acquired with an off axis Mach Zehnder interferometer. Microvascular hemodynamic components mapping is performed in the cerebral cortex of the mouse and the eye fundus of the rat with near-infrared laser light without any exogenous marker. These measures are made from a basic inverse method analysis of local first order optical fluctuation spectra at low radiofrequencies, from 0 Hz to 100 kHz. Local quadratic velocity is derived from Doppler broadenings induced by fluid flows, with elementary diffusing wave spectroscopy formalism in backscattering configuration. We demonstrate quadratic mean velocity assessment in the 0.1 to 10 millimeters per second range in vitro ...

  2. Statin use before diabetes diagnosis and risk of microvascular disease

    DEFF Research Database (Denmark)

    Nielsen, Sune F; Nordestgaard, Børge G

    2014-01-01

    BACKGROUND: The role of statins in the development of microvascular disease in patients with diabetes is unknown. We tested the hypothesis that statin use increases the risk of diabetic retinopathy, diabetic neuropathy, diabetic nephropathy, and gangrene of the foot in individuals with diabetes...... the cumulative incidence of diabetic retinopathy, diabetic neuropathy, diabetic nephropathy, or gangrene of the foot in statin users versus non-statin users. We analysed data with Cox regression models, adjusted for covariates including sex, age at diabetes diagnosis, and method of diabetes diagnosis. To address...... diabetic neuropathy, 1248 developed diabetic nephropathy, and 2392 developed gangrene of the foot. Compared with non-statin users, statin users had a lower cumulative incidence of diabetic retinopathy (hazard ratio 0·60, 95% CI 0·54-0·66; pdiabetic neuropathy (0·66, 0·57-0·75; p

  3. Threshold of microvascular occlusion: injury size defines the thrombosis scenario

    CERN Document Server

    Belyaev, Aleksey V; Ataullakhanov, Fazly I

    2014-01-01

    Damage to the blood vessel triggers a cascade of processes leading to the formation of a thrombus, which is meant to prevent bleeding. However, the same phenomenon may result in a total blockade of a blood vessel, causing severe medical conditions. Here we develop a mathematical model of thrombus growth in a microvessel, which demonstrates that the size of vascular injury acts like a switch between the regimes of thrombus growth. When the length of injury exceeds the critical value, thrombus occludes the vessel, otherwise the growth stops due to hydrodynamic shear forces. Our findings explain an experimentally observed distinctions between thrombosis induced by chemical lesion and laser injury. We suggest that the specifics of platelet adhesion in combination with microvascular hydrodynamics can be a major reason for cessation of thrombus growth in vivo.

  4. 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

  5. Polylactic Acid Nanoparticles Targeted to Brain Microvascular Endothelial Cells

    Institute of Scientific and Technical Information of China (English)

    WANG Huafang; HU Yu; SUN Wangqiang; XIE Changsheng

    2005-01-01

    In this work, blank polylactic acid (PLA) nanoparticles with unstained surface were prepared by the nano-deposition method. On the basis of the preparation, the effect of surface modification on brain microvascular endothelial cells (BMECs) targeting was examined by in vivo experiments and fluorescence microscopy. The results showed that PLA nanoparticles are less toxic than PACA nanoparticles but their BMECs targeting is similar to PACA nanoparticles. The experiments suggest that drugs can be loaded onto the particles and become more stable through adsorption on the surface of PLA nanoparticles with high surface activity. The surface of PLA nanoparticles was obviously modified and the hydrophilicity was increased as well in the presence of non-ionic surfactants on PLA nanoparticles. As a targeting moiety, polysobate 80 (T-80) can facilitate BMECs targeting of PLA nanoparticles.

  6. Spontaneous oscillations of capillary blood flow in artificial microvascular networks.

    Science.gov (United States)

    Forouzan, Omid; Yang, Xiaoxi; Sosa, Jose M; Burns, Jennie M; Shevkoplyas, Sergey S

    2012-09-01

    Previous computational studies have suggested that the capillary blood flow oscillations frequently observed in vivo can originate spontaneously from the non-linear rheological properties of blood, without any regulatory input. Testing this hypothesis definitively in experiments involving real microvasculature has been difficult because in vivo the blood flow in capillaries is always actively controlled by the host. The objective of this study was to test the hypothesis experimentally and to investigate the relative contribution of different blood cells to the capillary blood flow dynamics under static boundary conditions and in complete isolation from the active regulatory mechanisms mediated by the blood vessels in vivo. To accomplish this objective, we passed whole blood and re-constituted blood samples (purified red blood cells suspended in buffer or in autologous plasma) through an artificial microvascular network (AMVN) comprising completely inert, microfabricated vessels with the architecture inspired by the real microvasculature. We found that the flow of blood in capillaries of the AMVN indeed oscillates with characteristic frequencies in the range of 0-0.6 Hz, which is in a very good agreement with previous computational studies and in vivo observations. We also found that the traffic of leukocytes through the network (typically neglected in computational modeling) plays an important role in generating the oscillations. This study represents the key piece of experimental evidence in support of the hypothesis that spontaneous, self-sustained oscillations of capillary blood flow can be generated solely by the non-linear rheological properties of blood flowing through microvascular networks, and provides an insight into the mechanism of this fundamentally important microcirculatory phenomenon.

  7. 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.

  8. Uterine microvascular sensitivity to nanomaterial inhalation: An in vivo assessment.

    Science.gov (United States)

    Stapleton, P A; McBride, C R; Yi, J; Nurkiewicz, T R

    2015-11-01

    With the tremendous number and diverse applications of engineered nanomaterials incorporated in daily human activity, exposure can no longer be solely confined to occupational exposures of healthy male models. Cardiovascular and endothelial cell dysfunction have been established using in vitro and in situ preparations, but the translation to intact in vivo models is limited. Intravital microscopy has been used extensively to understand microvascular physiology while maintaining in vivo neurogenic, humoral, and myogenic control. However, a tissue specific model to assess the influences of nanomaterial exposure on female reproductive health has not been fully elucidated. Female Sprague Dawley (SD) rats were exposed to nano-TiO2 aerosols (171 ± 6 nm, 10.1 ± 0.39 mg/m(3), 5h) 24-hours prior to experimentation, leading to a calculated deposition of 42.0 ± 1.65 μg. After verifying estrus status, vital signs were monitored and the right horn of the uterus was exteriorized, gently secured over an optical pedestal, and enclosed in a warmed tissue bath using intravital microscopy techniques. After equilibration, significantly higher leukocyte-endothelium interactions were recorded in the exposed group. Arteriolar responsiveness was assessed using ionophoretically applied agents: muscarinic agonist acetylcholine (0.025 M; ACh; 20, 40, 100, and 200 nA), and nitric oxide donor sodium nitroprusside (0.05 M; SNP; 20, 40, and 100 nA), or adrenergic agonist phenylephrine (0.05 M; PE; 20, 40, and 100 nA) using glass micropipettes. Passive diameter was established by tissue superfusion with 10(-4)M adenosine. Similar to male counterparts, female SD rats present systemic microvascular dysfunction; however the ramifications associated with female health and reproduction have yet to be elucidated. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Uterine microvascular sensitivity to nanomaterial inhalation: An in vivo assessment☆

    Science.gov (United States)

    Stapleton, P.A.; McBride, C.R.; Yi, J.; Nurkiewicz, T.R.

    2015-01-01

    With the tremendous number and diverse applications of engineered nanomaterials incorporated in daily human activity, exposure can no longer be solely confined to occupational exposures of healthy male models. Cardiovascular and endothelial cell dysfunction have been established using in vitro and in situ preparations, but the translation to intact in vivo models is limited. Intravital microscopy has been used extensively to understand microvascular physiology while maintaining in vivo neurogenic, humoral, and myogenic control. However, a tissue specific model to assess the influences of nanomaterial exposure on female reproductive health has not been fully elucidated. Female Sprague Dawley (SD) rats were exposed to nano-TiO2 aerosols (171 ± 6 nm, 10.1 ± 0.39 mg/m3, 5 h) 24-hours prior to experimentation, leading to a calculated deposition of 42.0 ± 1.65 μg. After verifying estrus status, vital signs were monitored and the right horn of the uterus was exteriorized, gently secured over an optical pedestal, and enclosed in a warmed tissue bath using intravital microscopy techniques. After equilibration, significantly higher leukocyte-endothelium interactions were recorded in the exposed group. Arteriolar responsiveness was assessed using ionophoretically applied agents: muscarinic agonist acetylcholine (0.025 M; ACh; 20, 40, 100, and 200 nA), and nitric oxide donor sodium nitroprusside (0.05 M; SNP; 20, 40, and 100 nA), or adrenergic agonist phenylephrine (0.05 M; PE; 20, 40, and 100 nA) using glass micropipettes. Passive diameter was established by tissue superfusion with 10−4 M adenosine. Similar to male counterparts, female SD rats present systemic microvascular dysfunction; however the ramifications associated with female health and reproduction have yet to be elucidated. PMID:26375943

  10. Comprehensive Analysis of Chicken Vessels as Microvascular Anastomosis Training Model

    Science.gov (United States)

    Kang, Bo Young; Jeon, Byung-Joon; Lee, Kyeong-Tae

    2017-01-01

    Background Nonliving chickens are commonly used as a microvascular anastomosis training model. However, previous studies have investigated only a few types of vessel, and no study has compared the characteristics of the various vessels. The present study evaluated the anatomic characteristics of various chicken vessels as a training model. Methods Eight vessels—the brachial artery, basilic vein, radial artery, ulnar artery, ischiatic artery and vein, cranial tibial artery, and common dorsal metatarsal artery—were evaluated in 26 fresh chickens and 30 chicken feet for external diameter (ED) and thicknesses of the tunica adventitia and media. The dissection time from skin incision to application of vessel clamps was also measured. Results The EDs of the vessels varied. The ischiatic vein had the largest ED of 2.69±0.33 mm, followed by the basilic vein (1.88±0.36 mm), ischiatic artery (1.68±0.24 mm), common dorsal metatarsal artery (1.23±0.23 mm), cranial tibial artery (1.18±0.19 mm), brachial artery (1.08±0.15 mm), ulnar artery (0.82±0.13 mm), and radial artery (0.56±0.12 mm), and the order of size was consistent across all subjects. Thicknesses of the tunica adventitia and media were also diverse, ranging from 74.09±19.91 µm to 158.66±40.25 µm (adventitia) and from 31.2±7.13 µm to 154.15±46.48 µm (media), respectively. Mean dissection time was <3 minutes for all vessels. Conclusions Our results suggest that nonliving chickens can provide various vessels with different anatomic characteristics, which can allow trainees the choice of an appropriate microvascular anastomosis training model depending on their purpose and skillfulness. PMID:28194342

  11. Serum protein profiles predict coronary artery disease in symptomatic patients referred for coronary angiography

    Directory of Open Access Journals (Sweden)

    LaFramboise William A

    2012-12-01

    Full Text Available Abstract Background More than a million diagnostic cardiac catheterizations are performed annually in the US for evaluation of coronary artery anatomy and the presence of atherosclerosis. Nearly half of these patients have no significant coronary lesions or do not require mechanical or surgical revascularization. Consequently, the ability to rule out clinically significant coronary artery disease (CAD using low cost, low risk tests of serum biomarkers in even a small percentage of patients with normal coronary arteries could be highly beneficial. Methods Serum from 359 symptomatic subjects referred for catheterization was interrogated for proteins involved in atherogenesis, atherosclerosis, and plaque vulnerability. Coronary angiography classified 150 patients without flow-limiting CAD who did not require percutaneous intervention (PCI while 209 required coronary revascularization (stents, angioplasty, or coronary artery bypass graft surgery. Continuous variables were compared across the two patient groups for each analyte including calculation of false discovery rate (FDR ≤ 1% and Q value (P value for statistical significance adjusted to ≤ 0.01. Results Significant differences were detected in circulating proteins from patients requiring revascularization including increased apolipoprotein B100 (APO-B100, C-reactive protein (CRP, fibrinogen, vascular cell adhesion molecule 1 (VCAM-1, myeloperoxidase (MPO, resistin, osteopontin, interleukin (IL-1β, IL-6, IL-10 and N-terminal fragment protein precursor brain natriuretic peptide (NT-pBNP and decreased apolipoprotein A1 (APO-A1. Biomarker classification signatures comprising up to 5 analytes were identified using a tunable scoring function trained against 239 samples and validated with 120 additional samples. A total of 14 overlapping signatures classified patients without significant coronary disease (38% to 59% specificity while maintaining 95% sensitivity for patients requiring

  12. Patogênese da miocardite chagásica crônica: o papel de fatores autoimunes e microvasculares Chronic chagasic myocarditis pathogenesis: dependence on autoimmune and microvascular factors

    Directory of Open Access Journals (Sweden)

    Marcos A. Rossi

    1992-12-01

    Full Text Available A patogênese da miocardite chagásica crônica permanece incompletamente compreendida. Diferentes hipóteses têm sido propostas: (1 lesão direta do tecido pelo Trypanosoma cruzi;(2 teoria neurogênica; (3 reações imunológicas anti-miocárdio; e (4 doença microvascular. Apresentamos, no presente trabalho, uma hipótese alternativa. Acreditamos que o desenvolvimento da miocardite está relacionado à necrose celular focal progressiva e acumulativa, associada à fibrose intersticial reparativa e reativa e hipertrofia miocitária circunjacente. Esses processos seriam iniciados e perpetuados por fatores autoimunes e alterações na microcirculação do miocárdio. Esse mecanismo fisiopatogênico teria possíveis implicações em futuras estratégias terapêuticas no tratamento do paciente chagásico crônico visando otimizar o tratamento médico e auspiciosamente melhorar o prognóstico.The pathogenesis of chronic chagasic myocarditis remains incompletely understood. Several hypotheses have been proposed: (1 direct tissue destruction by Trypanosoma cruzi; (2 neurogenic theory; (3 anti-heart immune reactions; and (4 microvascular disease. We present herein a dynamic alternative hypothesis. We believe that the development of myocarditis is related to progressive and additive focal cellular necrosis, and associated reactive and reparative myocardial fibrosis and surrounding myocytes hypertrophy. These processes may be initiated and perpetuated by autoimmune factors and alterations in the myocardial microcirculation. This could imply future therapeutic strategies in the management of chronic chagasic patients to optimize the medical treatment and hopefully improve the prognosis.

  13. Current Indications for Coronary Arteriography

    OpenAIRE

    Dodek, Arthur

    1981-01-01

    Coronary arteriography is not necessary in all patients with angina pectoris. Angiography is indicated to define coronary anatomy in patients who have persistent angina despite full medication. It is also indicated in patients with a markedly positive stress test, unstable angina pectoris, positive stress test following myocardial infarction, variants of angina, ventricular aneurysm complications, and in the young coronary patient. Coronary arteriography may clarify the diagnosis in patients ...

  14. Cost-effectiveness analysis of personalized antiplatelet therapy in patients with acute coronary syndrome.

    Science.gov (United States)

    Jiang, Minghuan; You, Joyce Hs

    2016-05-01

    This study aimed to compare the clinical and economic outcomes of pharmacogenetic-guided (PG-guided) and platelet reactivity testing-guided antiplatelet therapy for patients with acute coronary syndrome undergoing percutaneous coronary intervention. A decision-analytic model was simulated including four antiplatelet strategies: universal clopidogrel 75 mg daily, universal alternative P2Y12 inhibitor (prasugrel or ticagrelor), PG-guided therapy, and platelet reactivity testing-guided therapy. PG-guided therapy was the preferred option with lowest cost (US$75,208) and highest quality-adjusted life years gained (7.6249 quality-adjusted life years). The base-case results were robust in sensitivity analysis. PG-guided antiplatelet therapy showed the highest probability to be preferred antiplatelet strategy for acute coronary syndrome patients with percutaneous coronary intervention.

  15. What Is Coronary Heart Disease?

    Science.gov (United States)

    ... from the NHLBI on Twitter. What Is Coronary Heart Disease? Español Coronary heart disease (CHD) is a disease in which a waxy ... medical procedures can help prevent or treat coronary heart disease. These treatments may reduce the risk of related ...

  16. Nuclear cardiology and coronary surgery

    DEFF Research Database (Denmark)

    Eckardt, R.; Andersen, L.I.; Hesse, B.

    2008-01-01

    Rising age, repeated percutaneous coronary revascularizations, and co-morbidity such as overweight, diabetes, and hypertension, characterize a change over the last 20-30 years in coronary patients referred to coronary artery bypass grafting (CABG). This patient group represents a great part of to...

  17. 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

  18. Effect of probucol in combination with statin on oxidated low density lipoprotein and high sensitive C reactive protein in patients with coronary heart disease%普罗布考联合他汀对冠心病患者氧化低密度脂蛋白胆固醇和高敏C反应蛋白的影响

    Institute of Scientific and Technical Information of China (English)

    赵明; 任艺虹; 周光

    2011-01-01

    目的 观察急性冠脉综合征(ACS)患者普罗布考联合他汀治疗组和单纯他汀组对氧化低密度脂蛋白(Ox-LDL)和高敏C反应蛋白(Hs-CRP)水平的影响.方法 选取2009年1月-2010年6月在我院心内科住院确诊急性冠脉综合征患者住院期间随机分为联合组和单纯组,两组均常规使用硝酸脂和抗血小板药物,联合组普罗布考0.75mg/d,2次/d;阿托伐他汀20mg/d,每晚1次.单纯组他汀用量及用法同联合组.随访3个月后测定Ox-LDL和Hs-CRP的表达,并进行两者的相关性分析.结果 治疗后联合组的Ox-LDL和Hs-CRP较单纯他汀组含量明显降低,分别为(409.3±42.1)μg/L比(487.2±65.2)μg/L,P<0.01;(3.28±1.11)mg/L比(3.93±1.76)mg/L,P<0.01.联合组和单纯治疗组患者血清Ox-LDL和Hs-CRP均呈显著正相关(r=0.773,P<0.01;r=0.724,P<0.01).结论 两组冠心病患者中Ox-LDL和Hs-CRP均存在较高的正相关,普罗布考联合他汀较单纯他汀治疗更能降低Ox-LDL和CRP的表达,提示普罗布考能够发挥较强大的抗动脉粥样硬化作用.%Objective To observe the effect of probucol in combination with statin on oxidated low density lipoprotein (Ox-LDL) and high sensitive C reactive protein (Hs-CRP) in patients with coronary heart disease. Methods Patients with acute coronary syndrome admitted to Department of Cardiology in our hospital from January 2009 to June 2010 were randomly divided into combined probucol and statin treatment group and simple statin treatment group. Patients in combined probucol and statin treatment group were treated with 0.75mg probucol (twice a day) and 20mg statin (once a day) plus nitrate esters and anti- platelet drugs. Patients in simple statin treatment group were treated with 20mg statin (once a day) plus nitrate esters and anti- platelet drugs. The patients were followed up for three months during which expressions of Ox-LDL and Hs-CRP were detected and their correlation was analyzed. Results The Ox-LDL and Hs

  19. Relationship between C-Reactive Protein and Body Mass Index in ...

    African Journals Online (AJOL)

    Baseline levels of C-reactive protein in apparently healthy men and women ... level CRP was found to be associated with a 10-year risk of coronary heart disease ... Key words: C-Reactive Protein, Body Mass Index, Type II diabetes Mellitus.

  20. Case Report: Coronary arterial spasm in single right coronary artery

    Institute of Scientific and Technical Information of China (English)

    En-zhi JIA; Qi-jun SHAN; Zhi-jian YANG; Tie-bing ZHU; Lian-sheng WANG; Ke-jiang CAO; Wen-zhu MA

    2009-01-01

    We presented a case of anomalous single-coronary artery detected incidentally during routine coronary angiography. A 32-year-old male Chinese patient presented with recurrent pre-syncope and six episodes of syncope. Coronary angiography and coronary-computed tomography (CT)-angiography performed by a dual-source computed tomography (DSCT) revealed that the patient had a single large right coronary artery. A moderately large branch originated from the proximal part of the single right coronary artery and extended to the left, passing the anterior to the pulmonary artery, and divided into the anterior descending artery branch and circumflex branch at the base of the left auricular appendage. The episodes of the syncope were suspected to be caused by coronary arterial spasm, so this patient was on a regimen of 30 mg of diltiazem every 6 h and had no recurrence of syncope during follow-up.

  1. Anomalous origin of right coronary artery from left coronary sinus.

    Science.gov (United States)

    Hamzeh, Gadah; Crespo, Alex; Estarán, Rafael; Rodríguez, Miguel A; Voces, Roberto; Aramendi, José I

    2008-08-01

    Anomalous aortic origin of the coronary arteries is uncommon but clinically significant. Manifestations vary from asymptomatic patients to those who present with angina pectoris, myocardial infarction, heart failure, syncope, arrhythmias, and sudden death. We describe 4 patients, aged 34 to 59 years, who were diagnosed with right coronary artery arising from the left sinus of Valsalva, confirmed by coronary angiography, which was surgically repaired. Three patients presented dyspnea and angina, and one with acute myocardial infarction. At operation, the right coronary artery was dissected at the take-off from the intramural course, and reimplanted into the right sinus of Valsalva. There was no mortality. One patient had associated coronary artery disease that required stent placement postoperatively. This reimplantation technique provides a good physiological and anatomical repair, eliminates a slit-like ostium, avoids compression of the coronary artery between the aorta and the pulmonary artery, and gives superior results to coronary artery bypass grafting or the unroofing technique.

  2. Coronary heart disease

    Institute of Scientific and Technical Information of China (English)

    1995-01-01

    950286 Percutaneous transluminal coronary angio-plasty for unstable angina.LIU Meilin(刘梅林),et.al.1st Teach Hosp,Beijing Med Univ,Beijing,100034.Chin J Intern Med 1995;34(3):169-172.Percutaneous transluminal coronary angioplasty(PTCA) was performed in 190 patients with 250 dis-eased vessels and 278 lesions from Dec.1987 to Feb.1994.All the patients had unstable angina (UA).There were 52(18.7%) type A lesions,175(62.9%)type B lesions and 51(18.3%) type C lesions.Of the

  3. 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.

  4. Platelet aggregation secondary to coronary obstruction.

    Science.gov (United States)

    Moore, S

    1976-03-01

    From many observations made at autopsy it is apparent that thrombosis in a coronary artery is usually, if not always, associated with rupture of an atheromatous plaque. The sequelae of such rupture include hemorrhage into the plaque with further narrowing of the lumen, formation of an occlusive thrombus or of a non-occlusive thrombus. A developing thrombus in an artery undergoes fragmentation with showering of the distal microcirculation by aggregates of platelets possibly with some admixture of fibrin. In many cases of sudden cardiac death associated with severe atherosclerotic stenosis of the coronary vessels, an occlusive thrombus is not found and the myocardium shows no morphological lesion or else focal patchy early damage in the subendocardial region. One possible mechanism that might explain these findings is microembolism from mural nonobstructing coronary thrombus. Such a mechanism is well established in transient ischemia of the brain and retina related to ulcerated atheroma of the internal carotid artery. Experimental observations indicate that platelet aggregates in the myocardial circulation cause arrhythmias, sudden death, vasculitis, and myocardial ischemic damage. Induction of an occlusive coronary artery thrombus is associated with development of an infarct involving the full thickness of the myocardium. A nonocclusive thrombus is associated with either no myocardial damage or focal subendocardial ischemic injury. It is possible that further aggregation of platelets may facilitate the extension of infarction subsequent to an occlusive event, although there is little evidence on this point. A number of clinical studies show increased platelet reactivity to agents causing aggregation, such as norepinephrine or collagen, in subjects experiencing thromboembolic episodes. It seems unlikely, however, that in vitro tests of platelet function can identify or predict clinical arterial thrombotic disease, although studies of platelet survival and turnover

  5. 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.

  6. Microvascular decompression of the posterior inferior cerebellar artery for intermediate nerve neuralgia

    Directory of Open Access Journals (Sweden)

    Humberto Kluge Schroeder

    2015-01-01

    Conclusion: INN should be considered as a differential diagnosis in cases with atypical facial neuralgia, and microvascular decompression is an effective treatment option that can provide optimal pain relief.

  7. Automated image analysis programs for the quantification of microvascular network characteristics.

    Science.gov (United States)

    Morin, Kristen T; Carlson, Paul D; Tranquillo, Robert T

    2015-08-01

    The majority of reports in which microvascular network properties are quantified rely on manual measurements, which are time consuming to collect and somewhat subjective. Despite some progress in creating automated image analysis techniques, the parameters measured by these methods are limited. For example, no automated system has yet been able to measure support cell recruitment, which is an important indicator of microvascular maturity. Microvessel alignment is another parameter that existing programs have not measured, despite a strong dependence of performance on alignment in some tissues. Here we present two image analysis programs, a semi-automated program that analyzes cross sections of microvascular networks and a fully automated program that analyzes images of whole mount preparations. Both programs quantify standard characteristics as well as support cell recruitment and microvascular network alignment, and were highly accurate in comparison to manual measurements for engineered tissues containing self-assembled microvessels. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Increased forearm blood flow in longstanding Type 1 diabetic patients without microvascular complications.

    NARCIS (Netherlands)

    Gurp, P.J.M. van; Lenders, J.W.M.; Tack, C.J.J.

    2007-01-01

    AIMS: According to the 'haemodynamic hypothesis', chronic hyperglycaemia induces an increase in tissue perfusion that predisposes to microangiopathy. We hypothesized that patients with longstanding diabetes mellitus (DM), who have not developed microvascular complications, would have normal tissue p

  9. Primary care diabetes bundle management: 3-year outcomes for microvascular and macrovascular events

    National Research Council Canada - National Science Library

    Bloom, Jr, Frederick J; Yan, Xiaowei; Stewart, Walter F; Graf, Thomas R; Anderer, Tammy; Davis, Duane E; Pierdon, Stevem B; Pitcavage, James; Steele, Jr, Glenn D

    2014-01-01

    To determine whether a system of care with an all-or-none bundled measure for primary-care management of diabetes mellitus reduced the risk of microvascular and macrovascular complications compared with usual care...

  10. SPONTANEOUSLY HYPERTENSIVE RATS ARE SUSCEPTIBLE TO MICROVASCULAR THROMBOSIS IN RESPONSE TO PARTICULATE MATTER EXPOSURE

    Science.gov (United States)

    SPONTANEOUSLY HYPERTENSIVE RATS ARE SUSCEPTIBLE TO MICROVASCULAR THROMBOSIS IN RESPONSE TO PARTICULATE MATTER EXPOSURE.PS Gilmour, MC Schladweiler, AD Ledbetter, and UP Kodavanti. US EPA, ORD, NHEERL, ETD, PTB, Research Triangle Park, NC USA. Environmental particles (PM...

  11. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); M-C. Morice (Marie-Claude); A.P. Kappetein (Arie Pieter); A. Colombo (Antonio); D.R. Holmes Jr (David); M.J. Mack (Michael); E. Stahle (Elisabeth); T.E. Feldman (Ted); M.J.B.M. van den Brand (Marcel); E.J. Bass (Eric); N. van Dyck (Nic); K. Leadly (Katrin); K.D. Dawkins (Keith); F.W. Mohr (Friedrich)

    2009-01-01

    textabstractBACKGROUND Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating pat

  12. Microvascular patterns in the blubber of shallow and deep diving odontocetes.

    Science.gov (United States)

    McClelland, Sara J; Gay, Mark; Pabst, D Ann; Dillaman, Richard; Westgate, Andrew J; Koopman, Heather N

    2012-08-01

    Blubber, a specialized form of subdermal adipose tissue, surrounds marine mammal bodies. Typically, adipose tissue is perfused by capillaries but information on blubber vascularization is lacking. This study's goals were to: 1) describe and compare the microvasculature (capillaries, microarterioles, and microvenules) of blubber across odontocete species; 2) compare microvasculature of blubber to adipose tissue; and 3) examine relationships between blubber's lipid composition and its microvasculature. Percent microvascularity, distribution, branching pattern, and diameter of microvessels were determined from images of histochemically stained blubber sections from shallow-diving bottlenose dolphins (Tursiops truncatus), deeper-diving pygmy sperm whales (Kogia breviceps), deep-diving beaked whales (Mesoplodon densirostris; Ziphius cavirostris), and the subdermal adipose tissue of domestic pigs (Sus scrofa). Tursiops blubber showed significant stratification in percent microvascularity among the superficial, middle, and deep layers and had a significantly higher percent microvascularity than all other animals analyzed, in which the microvasculature was more uniformly distributed. The percent microvasculature of Kogia blubber was lower than that of Tursiops but higher than that of beaked whales and the subdermal adipose tissue of domestic pigs. Tursiops had the most microvascular branching. Microvessel diameter was relatively uniform in all species. There were no clear patterns associating microvascular and lipid characteristics. The microvascular characteristics of the superficial layer of blubber resembled the adipose tissue of terrestrial mammals, suggesting some conservation of microvascular patterns in mammalian adipose tissue. The middle and deep layers of blubber, particularly in Tursiops, showed the greatest departure from typical mammalian microvascular arrangement. Factors such as metabolics or thermoregulation may be influencing the microvasculature in these

  13. Interactions of the gasotransmitters contribute to microvascular tone (dysregulation in the preterm neonate.

    Directory of Open Access Journals (Sweden)

    Rebecca M Dyson

    Full Text Available Hydrogen sulphide (H2S, nitric oxide (NO, and carbon monoxide (CO are involved in transitional microvascular tone dysregulation in the preterm infant; however there is conflicting evidence on the interaction of these gasotransmitters, and their overall contribution to the microcirculation in newborns is not known. The aim of this study was to measure the levels of all 3 gasotransmitters, characterise their interrelationships and elucidate their combined effects on microvascular blood flow.90 preterm neonates were studied at 24h postnatal age. Microvascular studies were performed by laser Doppler. Arterial COHb levels (a measure of CO were determined through co-oximetry. NO was measured as nitrate and nitrite in urine. H2S was measured as thiosulphate by liquid chromatography. Relationships between levels of the gasotransmitters and microvascular blood flow were assessed through partial correlation controlling for the influence of gestational age. Structural equation modelling was used to examine the combination of these effects on microvascular blood flow and derive a theoretical model of their interactions.No relationship was observed between NO and CO (p = 0.18, r = 0.18. A positive relationship between NO and H2S (p = 0.008, r = 0.28 and an inverse relationship between CO and H2S (p = 0.01, r = -0.33 exists. Structural equation modelling was used to examine the combination of these effects on microvascular blood flow. The model with the best fit is presented.The relationships between NO and H2S, and CO and H2S may be of importance in the preterm newborn, particularly as NO levels in males are associated with higher H2S levels and higher microvascular blood flow and CO in females appears to convey protection against vascular dysregulation. Here we present a theoretical model of these interactions and their overall effects on microvascular flow in the preterm newborn, upon which future mechanistic studies may be based.

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

    OpenAIRE

    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 ...

  15. 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.

  16. Coronary artery anatomy and variants

    Energy Technology Data Exchange (ETDEWEB)

    Malago, Roberto; Pezzato, Andrea; Barbiani, Camilla; Alfonsi, Ugolino; Nicoli, Lisa; Caliari, Giuliana; Pozzi Mucelli, Roberto [Policlinico G.B. Rossi, University of Verona, Department of Radiology, Verona (Italy)

    2011-12-15

    Variants and congenital anomalies of the coronary arteries are usually asymptomatic, but may present with severe chest pain or cardiac arrest. The introduction of multidetector CT coronary angiography (MDCT-CA) allows the detection of significant coronary artery stenosis. Improved performance with isotropic spatial resolution and higher temporal resolution provides a valid alternative to conventional coronary angiography (CCA) in many patients. MDCT-CA is now considered the ideal tool for three-dimensional visualization of the complex and tortuous anatomy of the coronary arteries. With multiplanar and volume-rendered reconstructions, MDCT-CA may even outperform CCA in determining the relative position of vessels, thus providing a better view of the coronary vascular anatomy. The purpose of this review is to describe the normal anatomy of the coronary arteries and their main variants based on MDCT-CA with appropriate reconstructions. (orig.)

  17. [Pregnancy and coronary artery dissection].

    Science.gov (United States)

    Martínez-Quintana, Efrén; Rodríguez-González, Fayna

    2015-01-01

    Acute myocardial infarction during pregnancy is associated with high maternal and fetal mortality. Coronary atherosclerosis is the most common cause due to an increase in the age of the patients and the association with cardiovascular risk factors such as smoking, hypertension, diabetes mellitus, preeclampsia, and the existence of family history of coronary disease. However, thrombosis, coronary dissection or coronary vasospasms are other causes that may justify it. We report the case of a 33 weeks pregnant first-time mother, without cardiovascular risk factors, who presented an acute coronary event in the context of atherosclerotic disease and coronary dissection after percutaneous coronary intervention. Copyright © 2014 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  18. Classification of microvascular patterns via cluster analysis reveals their prognostic significance in glioblastoma.

    Science.gov (United States)

    Chen, Long; Lin, Zhi-Xiong; Lin, Guo-Shi; Zhou, Chang-Fu; Chen, Yu-Peng; Wang, Xing-Fu; Zheng, Zong-Qing

    2015-01-01

    There are limited researches focusing on microvascular patterns (MVPs) in human glioblastoma and their prognostic impact. We evaluated MVPs of 78 glioblastomas by CD34/periodic acid-Schiff dual staining and by cluster analysis of the percentage of microvascular area for distinct microvascular formations. The distribution of 5 types of basic microvascular formations, that is, microvascular sprouting (MS), vascular cluster (VC), vascular garland (VG), glomeruloid vascular proliferation (GVP), and vasculogenic mimicry (VM), was variable. Accordingly, cluster analysis classified MVPs into 2 types: type I MVP displayed prominent MSs and VCs, whereas type II MVP had numerous VGs, GVPs, and VMs. By analyzing the proportion of microvascular area for each type of formation, we determined that glioblastomas with few MSs and VCs had many GVPs and VMs, and vice versa. VG seemed to be a transitional type of formation. In case of type I MVP, expression of Ki-67 and p53 but not MGMT was significantly higher as compared with those of type II MVP (P analysis showed that the type of MVPs presented as an independent prognostic factor of progression-free survival (PFS) and overall survival (OS) (both P < .001). Type II MVP had a more negative influence on PFS and OS than did type I MVP. We conclude that the heterogeneous MVPs in glioblastoma can be categorized properly by certain histopathologic and statistical analyses and may influence clinical outcome. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

  19. Added Qualifications in Microsurgery: Consideration for Subspecialty Certification in Microvascular Surgery in Europe.

    Science.gov (United States)

    Heidekrueger, Paul I; Tanna, Neil; Weichman, Katie E; Szpalski, Caroline; Tos, Pierluigi; Ninkovic, Milomir; Broer, P Niclas

    2016-07-01

    Background While implementation of subspecializations may increase expertise in a certain area of treatment, there also exist downsides. Aim of this study was, across several disciplines, to find out if the technique of microsurgery warrants the introduction of a "Certificate of Added Qualifications (CAQ) in microsurgery." Methods An anonymous, web-based survey was administered to directors of microsurgical departments in Europe (n = 205). Respondents were asked, among other questions, whether they had completed a 12-month microvascular surgery fellowship and whether they believed a CAQ in microvascular surgery should be instituted. Results The response rate was 57%, and 33% of the respondents had completed a 12-month microvascular surgery fellowship.A total of 61% of all surgeons supported a CAQ in microsurgery. Answers ranged from 47% of support to 100% of support, depending on the countries surveyed. Discussion This is one of the few reports to evaluate the potential role of subspecialty certification of microvascular surgery across several European countries. The data demonstrate that the majority of directors of microsurgical departments support such a certificate. There was significantly greater support for a CAQ in microsurgery among those who have completed a formal microvascular surgery fellowship themselves. Conclusion This study supports the notion that further discussion and consideration of subspecialty certification in microvascular surgery appears necessary. There are multiple concerns surrounding this issue. Similar to the evolution of hand surgery certification, an exploratory committee of executive members of the respective medical boards and official societies may be warranted.

  20. Does the quantitative assessment of coronary artery dimensions predict the physiologic significance of a coronary stenosis?

    NARCIS (Netherlands)

    F. Zijlstra (Felix); J.C.W. van Ommeren (Jan-Kees); J.H.C. Reiber (Johan); P.W.J.C. Serruys (Patrick)

    1987-01-01

    textabstractTo study the relationship between the quantitatively assessed coronary artery dimensions and the regional coronary flow reserve as measured by digital subtraction cineangiography, we investigated 17 coronary arteries with a single discrete proximal stenosis and 12 normal coronary

  1. 急性冠脉综合征中超敏C反应蛋白联合D-二聚体检测的研究进展%THE DEVELOPMENT OF COMBINED TESTING OF HYPER-SENSITIVE C REACTIVE PROTEIN AND D-DIMER IN ACUTE CORONARY SYMDROME

    Institute of Scientific and Technical Information of China (English)

    杜丽萍; 扈瑞平; 王学磊; 曾显坤

    2015-01-01

    ACS的临床表现可为,胸闷、胸痛伴气短、出汗,心衰,心律失常以及猝死。并伴有冠脉血管痉挛,管腔明显狭窄,甚至完全被堵塞,从而出现心肌缺血缺氧,严重时心肌坏死[1]。近年来研究发现:其进展过程中伴随的生化标记物超敏C反应蛋白、D-二聚体的改变可帮助临床医师及早识别病人的临床症状并为心电图改变不典型病人提供积极个体化的治疗方案,同时对评估其病情及预后、起到极大的作用。现将对急性冠脉综合征中( ACS)超敏C反应蛋白联合D-二聚体检测的研究进展进行综述。%Acute coronary symdrome( ACS) is caused by cononary atherosclerosis rupture, platelet adhesion, platelet aggregation, platelet release, through which the coagulation system is activated leading to the blood clot. ACS is usually accompanied by vasospasm,stenosis of arte-rioles,even worse,myocardial ischemia from completely blocking and myocardial necrosis. The research tells us that through biochemical marker-hyper sensitive C reactive protein and D-dimer ( increase ) , phisician can recognize some symdromes in early time,help ACS patients with atypical ECG changes and give them individual treatment;in addition,the two marker also play an important role in evaluating severity and prognosis. This review will present development in application of hyper-sensitive C reative protein and D-dimer in ACS.

  2. 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.

  3. 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)

  4. [Acute coronary syndrome -- 2012].

    Science.gov (United States)

    Becker, Dávid; Merkely, Béla

    2012-12-23

    The acute coronary syndrome is the most severe form of coronary artery disease. It is an immediate threat of life and the mortality rate can be high without proper therapy and patient management. Based on the first ECG, two different forms can be distinguished: acute coronary syndrome with and without ST elevation. Besides adequate medication, management of these patients is an essential part of treatment. In case of ST elevation, coronarography and percutaneous coronary intervention is needed in general, within 24 hours from the onset of symptoms. When ST elevation is not detected on the ECG, individual ischemic risk factors and predictable mortality of the patient may define the necessity and the date of the invasive examination. The Hungarian hemodynamic laboratory network covers almost the whole country and, therefore, practically each patient may receive a state-of-the-art therapy. Although indicators of cardiovascular diseases are still prominent, the mortality rate of myocardial Infarction is decreasing in Hungary due to the well-organized invasive care.

  5. [Acute coronary syndrome suspicion in patient with left coronary artery arising from right coronary sinus].

    Science.gov (United States)

    Kern, Adam; Górny, Jerzy; Rzeszowski, Bartłomiej; Witkowska, Ewa; Wasilewski, Grzegorz

    2013-01-01

    We present a case of 73 year-old patient who underwent coronary angiography due to suspicion of acute coronary syndrome without persistent ST segment elevation. The angiographic result showed no lesions that could cause recurrent chest pain,but it also revealed a seldom coronary artery abnormality - left coronary artery arising from right coronary sinus. Performed computed tomography of the chest confirmed the result of the coronarography. But apart from that it found the signs of neoplastic disease which was probably responsible for clinical presentation.

  6. Impact of coronary tortuosity on coronary pressure: numerical simulation study.

    Directory of Open Access Journals (Sweden)

    Yang Li

    Full Text Available BACKGROUND: Coronary tortuosity (CT is a common coronary angiographic finding. Whether CT leads to an apparent reduction in coronary pressure distal to the tortuous segment of the coronary artery is still unknown. The purpose of this study is to determine the impact of CT on coronary pressure distribution by numerical simulation. METHODS: 21 idealized models were created to investigate the influence of coronary tortuosity angle (CTA and coronary tortuosity number (CTN on coronary pressure distribution. A 2D incompressible Newtonian flow was assumed and the computational simulation was performed using finite volume method. CTA of 30°, 60°, 90°, 120° and CTN of 0, 1, 2, 3, 4, 5 were discussed under both steady and pulsatile conditions, and the changes of outlet pressure and inlet velocity during the cardiac cycle were considered. RESULTS: Coronary pressure distribution was affected both by CTA and CTN. We found that the pressure drop between the start and the end of the CT segment decreased with CTA, and the length of the CT segment also declined with CTA. An increase in CTN resulted in an increase in the pressure drop. CONCLUSIONS: Compared to no-CT, CT can results in more decrease of coronary blood pressure in dependence on the severity of tortuosity and severe CT may cause myocardial ischemia.

  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. Delayed increases in microvascular pathology after experimental traumatic brain injury are associated with prolonged inflammation, blood-brain barrier disruption, and progressive white matter damage.

    Science.gov (United States)

    Glushakova, Olena Y; Johnson, Danny; Hayes, Ronald L

    2014-07-01

    Traumatic brain injury (TBI) is a significant risk factor for chronic traumatic encephalopathy (CTE), Alzheimer's disease (AD), and Parkinson's disease (PD). Cerebral microbleeds, focal inflammation, and white matter damage are associated with many neurological and neurodegenerative disorders including CTE, AD, PD, vascular dementia, stroke, and TBI. This study evaluates microvascular abnormalities observed at acute and chronic stages following TBI in rats, and examines pathological processes associated with these abnormalities. TBI in adult rats was induced by controlled cortical impact (CCI) of two magnitudes. Brain pathology was assessed in white matter of the corpus callosum for 24 h to 3 months following injury using immunohistochemistry (IHC). TBI resulted in focal microbleeds that were related to the magnitude of injury. At the lower magnitude of injury, microbleeds gradually increased over the 3 month duration of the study. IHC revealed TBI-induced focal abnormalities including blood-brain barrier (BBB) damage (IgG), endothelial damage (intercellular adhesion molecule 1 [ICAM-1]), activation of reactive microglia (ionized calcium binding adaptor molecule 1 [Iba1]), gliosis (glial fibrillary acidic protein [GFAP]) and macrophage-mediated inflammation (cluster of differentiation 68 [CD68]), all showing different temporal profiles. At chronic stages (up to 3 months), apparent myelin loss (Luxol fast blue) and scattered deposition of microbleeds were observed. Microbleeds were surrounded by glial scars and co-localized with CD68 and IgG puncta stainings, suggesting that localized BBB breakdown and inflammation were associated with vascular damage. Our results indicate that evolving white matter degeneration following experimental TBI is associated with significantly delayed microvascular damage and focal microbleeds that are temporally and regionally associated with development of punctate BBB breakdown and progressive inflammatory responses. Increased

  9. Measurement of Coronary-Prone Behavior and Autonomic Reactivity.

    Science.gov (United States)

    1981-05-01

    neurochemical parallels of psychopathology; a psychophysiological model relating autonomic imbalance to hyper- activity, psychopathy and autism. In... Psychopathy and physiological responses to threat of an aversive stimulus. Psychophysiology, 1978, 15(2), 165-172. 197. Berkeley, A.W. Level of aspiration

  10. Hostility, Anger and Risk of Coronary Artery Atherosclerosis

    Directory of Open Access Journals (Sweden)

    E Masoudnia

    2011-02-01

    Full Text Available Introduction: The previous researches about the etiology of coronary artery atherosclerosis have accentuated on clinical and medical risk factors, such as cigarette smoking, hypertension, diabetes mellitus, hyperlipidemia, positive family background, myocardial ischemia history in family, atherogenic diet, increase of A lipoprotein, inflammatory factors such as increase of cross-reactive protein and so on. Although factors in behavioral medicine are recognized as an independent risk factor in coronary artery atherosclerosis, few researches have been done on hostility and anger. The aim of this study was to determine the difference between normal people(Control group and people with coronary artery atherosclerosis(Case group with regards to hostility and anger. Methods: This study was performed as a case-control design. Data was collected from seventy-seven patients with coronary artery atherosclerosis who had referred to Afshar Hospital Professional Heart Clinic in Yazd city and seventy-eight normal people were used as control. Two groups completed the Buss and Perry Aggression Questionnaire(BPAQ to measure their hostility and anger. Results: The results of the analysis showed that there was a statistically significant difference regarding hostility(p<.05 and anger(p<.001 between the two groups. Hierarchical multiple logistic regression analysis showed that the sociodemographic and clinical variables(step 1 explained 35.5 % to 47.4%, while hostility and anger(step 2 explained 6.7% to 9% of the variance in incidence of coronary artery atherosclerosis. Conclusion: Hostility and anger are strong risk factors for coronary artery atherosclerosis or CAD in Iran. Therefore, in order to decrease the incidence rate of coronary artery atherosclerosis in Iran, alongside medical interventions, attention should also be paid towards behavioral interventions in order to modify hostile and angrily behavior.

  11. CT coronary angiography vs. invasive coronary angiography in CHD

    Directory of Open Access Journals (Sweden)

    Anja Hagen

    2012-04-01

    Full Text Available Scientific background: Various diagnostic tests including conventional invasive coronary angiography and non-invasive computed tomography (CT coronary angiography are used in the diagnosis of coronary heart disease (CHD. Research questions: The present report aims to evaluate the clinical efficacy, diagnostic accuracy, prognostic value cost-effectiveness as well as the ethical, social and legal implications of CT coronary angiography versus invasive coronary angiography in the diagnosis of CHD. Methods: A systematic literature search was conducted in electronic data bases (MEDLINE, EMBASE etc. in October 2010 and was completed with a manual search. The literature search was restricted to articles published from 2006 in German or English. Two independent reviewers were involved in the selection of the relevant publications. The medical evaluation was based on systematic reviews of diagnostic studies with invasive coronary angiography as the reference standard and on diagnostic studies with intracoronary pressure measurement as the reference standard. Study results were combined in a meta-analysis with 95 % confidence intervals (CI. Additionally, data on radiation doses from current non-systematic reviews were taken into account. A health economic evaluation was performed by modelling from the social perspective with clinical assumptions derived from the meta-analysis and economic assumptions derived from contemporary German sources. Data on special indications (bypass or in-stent-restenosis were not included in the evaluation. Only data obtained using CT scanners with at least 64 slices were considered. Results: No studies were found regarding the clinical efficacy or prognostic value of CT coronary angiography versus conventional invasive coronary angiography in the diagnosis of CHD. Overall, 15 systematic reviews with data from 44 diagnostic studies using invasive coronary angiography as the reference standard (identification of obstructive

  12. The relationship between anxiety and serum levels of c-reactive protein and interleukin-6 in the elderly patients with coronary heart disease%血清C-反应蛋白、白细胞介素-6水平与老年冠心病患者焦虑情绪的关系

    Institute of Scientific and Technical Information of China (English)

    张晓玲; 阿依吐尔汉·马合木提; 古丽扎尔·买买提明; 帕丽达·阿布来提

    2012-01-01

    目的:探讨血清炎性因子C-反应蛋白(CRP)、白细胞介素(IL-6)水平与老年冠心病患者伴焦虑情绪的相关性. 方法:收集老年冠心病患者64例,进行焦虑自评量表(SAS)评分,根据评分结果将其分为冠心病不伴焦虑情绪组、冠心病伴焦虑情绪组,测定所有研究对象的血清CRP、IL-6水平.结果:64例患者中男性36例(56.25%),女性28例(43.75%),伴有焦虑情绪35例(47.45%),其中男性有15例(42.9%),女性20例(57.1%),男女冠心病患者伴焦虑情绪差异有统计学意义(P<0.05).伴有焦虑情绪的血清CRP、IL-6水平与不伴有焦虑情绪的差异有统计学意义(P<0.05).血清炎症因子水平CRP、IL-6与焦虑程度呈正相关. 结论:伴有焦虑情绪的老年冠心病患者血清CRP、IL-6水平升高,且与焦虑程度呈正相关.%Objective:To investigate the relationship between anxiety and serum levels of inflammatory factors C-reactive protein (CRP) and interleukin-6 (IL-6) in the elderly patients with coronary heart disease (CHD) Method: The self-rating anxiety scale (SAS) was applied to 64 patients with CHD. According to SAS score, 64 patients were divided into two groups: elderly CHD patient with and without anxiety symptom group. The serum levels of inflammatory factors including C-reactive protein (CRP) Jnterleukin-6( IL-6) were tested. Results: All of subjects, male 36 (56. 25% ) and female 28 (43. 75% ), 35 (47. 45% ) patients showed anxiety including 15 (42.9% )male and 20 (57. 1% ) female patients. The sex difference was found in anxiety (P <0.05). The difference on CRP and IL-6 between with and without anxiety symptom group was statistically significant. The levels of Inflammatory factors CRP, IL-6 and anxiety level were positively correlated. Conclusion:Serum levels of CRP and IL-6 in the elderly CHD patients with anxiety are higher than those in the elderly CHD patients without anxiety, and associated with anxiety.

  13. Differential effects of androgens on coronary blood flow regulation and arteriolar diameter in intact and castrated swine

    Directory of Open Access Journals (Sweden)

    O’Connor Erin K

    2012-05-01

    Full Text Available Abstract Background Low endogenous testosterone levels have been shown to be a risk factor for the development of cardiovascular disease and cardiovascular benefits associated with testosterone replacement therapy are being advocated; however, the effects of endogenous testosterone levels on acute coronary vasomotor responses to androgen administration are not clear. The objective of this study was to compare the effects of acute androgen administration on in vivo coronary conductance and in vitro coronary microvascular diameter in intact and castrated male swine. Methods Pigs received intracoronary infusions of physiologic levels (1–100 nM of testosterone, the metabolite 5α-dihydrotestosterone, and the epimer epitestosterone while left anterior descending coronary blood flow and mean arterial pressure were continuously monitored. Following sacrifice, coronary arterioles were isolated, cannulated, and exposed to physiologic concentrations (1–100 nM of testosterone, 5α-dihydrotestosterone, and epitestosterone. To evaluate effects of the androgen receptor on acute androgen dilation responses, real-time PCR and immunohistochemistry for androgen receptor were performed on conduit and resistance coronary vessels. Results In vivo, testosterone and 5α-dihydrotestosterone produced greater increases in coronary conductance in the intact compared to the castrated males. In vitro, percent maximal dilation of microvessels was similar between intact and castrated males for testosterone and 5α-dihydrotestosterone. In both studies epitestosterone produced significant increases in conductance and microvessel diameter from baseline in the intact males. Androgen receptor mRNA expression and immunohistochemical staining were similar in intact and castrated males. Conclusions Acute coronary vascular responses to exogenous androgen administration are increased by endogenous testosterone, an effect unrelated to changes in androgen receptor expression.

  14. 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

  15. Cross-reacting antibacterial auto-antibodies are produced within coronary atherosclerotic plaques of acute coronary syndrome patients.

    Directory of Open Access Journals (Sweden)

    Filippo Canducci

    Full Text Available Coronary atherosclerosis, the main condition predisposing to acute myocardial infarction, has an inflammatory component caused by stimuli that are yet unknown. We molecularly investigated the nature of the immune response within human coronary lesion in four coronary plaques obtained by endoluminal atherectomy from four patients. We constructed phage-display libraries containing the IgG1/kappa antibody fragments produced by B-lymphocytes present in each plaque. By immunoaffinity, we selected from these libraries a monoclonal antibody, arbitrarily named Fab7816, able to react both with coronary and carotid atherosclerotic tissue samples. We also demonstrated by confocal microscopy that this monoclonal antibody recognized human transgelin type 1, a cytoskeleton protein involved in atherogenesis, and that it co-localized with fibrocyte-like cells transgelin+, CD68+, CD45+ in human sections of coronary and carotid plaques. In vitro fibrocytes obtained by differentiating CD14+ cells isolated from peripheral blood mononuclear cells also interacted with Fab7816, thus supporting the hypothesis of a specific recognition of fibrocytes into the atherosclerotic lesions. Interestingly, the same antibody, cross-reacted with the outer membrane proteins of Proteus mirabilis and Klebsiella pneumoniae (and possibly with homologous proteins of other enterobacteriaceae present in the microbiota. From all the other three libraries, we were able to clone, by immunoaffinity selection, human monoclonal antibodies cross-reacting with bacterial outer membrane proteins and with transgelin. These findings demonstrated that in human atherosclerotic plaques a local cross-reactive immune response takes place.

  16. 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.

  17. Brain microvascular endothelial cell transplantation ameliorates ischemic white matter damage.

    Science.gov (United States)

    Puentes, Sandra; Kurachi, Masashi; Shibasaki, Koji; Naruse, Masae; Yoshimoto, Yuhei; Mikuni, Masahiko; Imai, Hideaki; Ishizaki, Yasuki

    2012-08-21

    Ischemic insults affecting the internal capsule result in sensory-motor disabilities which adversely affect the patient's life. Cerebral endothelial cells have been reported to exert a protective effect against brain damage, so the transplantation of healthy endothelial cells might have a beneficial effect on the outcome of ischemic brain damage. In this study, endothelin-1 (ET-1) was injected into the rat internal capsule to induce lacunar infarction. Seven days after ET-1 injection, microvascular endothelial cells (MVECs) were transplanted into the internal capsule. Meningeal cells or 0.2% bovine serum albumin-Hank's balanced salt solution were injected as controls. Two weeks later, the footprint test and histochemical analysis were performed. We found that MVEC transplantation improved the behavioral outcome based on recovery of hind-limb rotation angle (P<0.01) and induced remyelination (P<0.01) compared with the control groups. Also the inflammatory response was repressed by MVEC transplantation, judging from fewer ED-1-positive activated microglial cells in the MVEC-transplanted group than in the other groups. Elucidation of the mechanisms by which MVECs ameliorate ischemic damage of the white matter may provide important information for the development of effective therapies for white matter ischemia.

  18. Quantitative and qualitative retinal microvascular characteristics and blood pressure.

    Science.gov (United States)

    Cheung, Carol Y; Tay, Wan T; Mitchell, Paul; Wang, Jie J; Hsu, Wynne; Lee, Mong L; Lau, Qiangfeng P; Zhu, Ai L; Klein, Ronald; Saw, Seang M; Wong, Tien Y

    2011-07-01

    The present study examined the effects of blood pressure on a spectrum of quantitative and qualitative retinal microvascular signs. Retinal photographs from the Singapore Malay Eye Study, a population-based cross-sectional study of 3280 (78.7% response) persons aged 40-80 years, were analyzed. Quantitative changes in the retinal vasculature (branching angle, vascular tortuosity, fractal dimension, and vascular caliber) were measured using a semi-automated computer-based program. Qualitative signs, including focal arteriolar narrowing (FAN), arteriovenous nicking (AVN), opacification of the arteriolar wall (OAW), and retinopathy (e.g., microaneurysms, retinal hemorrhages), were assessed from photographs by trained technicians. After excluding persons with diabetes and ungradable photographs, 1913 persons provided data for this analysis. In multivariable linear regression models controlling for age, sex, BMI, use of antihypertensive medication, and other factors, retinal arteriolar branching asymmetry ratio, arteriolar tortuosity, venular tortuosity, fractal dimension, arteriolar caliber, venular caliber, FAN, AVN, and retinopathy were independently associated with mean arterial blood pressure. In contrast, arteriolar/venular branching angle, venular branching asymmetry ratio and OAW were not related to blood pressure. Retinal arteriolar caliber (sβ = -0.277) and FAN (sβ = 0.170) had the strongest associations with mean arterial blood pressure, and higher blood pressure levels were associated with increasing number of both quantitative and qualitative retinal vascular signs (P trend qualitative retinal vascular signs, with the number of signs increasing with higher blood pressure levels.

  19. 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.

  20. 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.

  1. Treatment of atypical trigeminal neuralgia with microvascular decompression

    Directory of Open Access Journals (Sweden)

    Hai Jian

    2006-01-01

    Full Text Available Aim: To explore the methods for achieving pain relief in patients with atypical trigeminal neuralgia (TN using microvascular decompression (MVD. Study Design and Settings: Retrospective study of 26 patients treated during the years 2000 to 2004. Materials and Methods: Twenty-six patients in whom vascular compression of the trigeminal nerve was identified by high definition magnetic resonance tomographic angiography (MRTA were treated with MVD for atypical TN in our department. Clinical presentations, surgical findings and clinical outcomes were analyzed retrospectively. Results: In this study, single trigeminal division was involved in only 2 patients (8% and two or three divisions in the other 24 patients (92%. Of prime importance is the fact that in 46.2% of the patients, several conflicting vessels were found in association. Location of the conflicts around the circumference of the trigeminal root was supero-medial to the root in 53.5%, supero-lateral in 30.8% and inferior in 15.7%. MVD for atypical TN resulted in complete pain relief in 50% of the patients with complete decompression, partial pain relief in 30.8% and poor pain relief or pain recurrence in 19.2% of the patients without complete decompression postoperatively. Conclusions: Complete decompression of the entire trigeminal root plays an important role in achieving pain relief in patients with atypical TN with MVD.

  2. 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 

  3. Delayed facial palsy after microvascular decompression: Report of two cases

    Directory of Open Access Journals (Sweden)

    G Lakshmi Prasad

    2017-01-01

    Full Text Available Microvascular decompression (MVD is a novel surgical procedure predominantly performed for treating trigeminal neuralgia (TN and hemifacial spasm (HS. Multiple studies have proven the long-term success of MVD for both these conditions. The most common complications of MVD reported include chemical meningitis, facial hypesthesia, cerebrospinal fluid leak, facial paresis, and hearing loss. Delayed facial palsy (DFP is an uncommon complication mostly noted in MVD for HS and after the removal of acoustic tumors. We report two cases of DFP occurring after performing MVD, one each for HS and TN. This is also the first case of DFP to be reported after MVD for TN. Both were young females who developed DFP 2 weeks after surgery. They were managed with oral steroids and acyclovir for 2–3 weeks and achieved excellent outcome at an average of 4.5 weeks from the onset. We conclude that although majority of the cases improve spontaneously, steroids and acyclovir might assist in faster recovery.

  4. Microvascular radial forearm fasciocutaneous free flap in hard palate reconstruction.

    Science.gov (United States)

    Duflo, S; Lief, F; Paris, J; Giovanni, A; Thibeault, S; Zanaret, M

    2005-09-01

    To report the reconstruction of palatal defects by microvascular radial forearm fasciocutaneous free flap (RFFF) and to report patient's quality of life outcomes after this procedure. During the period 1990-2002, 30 cases of palatal defects were reconstructed using RFFF in our institution. RFFF allowed restoration of a vestibular sulcus to maintain dental prostheses. Outcome measurements included post-operative assessment of speech, swallowing and diet evaluation 6 months, 1 year and 2 years after reconstruction. Quality of life outcomes were measured 1 and 2 years post-reconstruction. RFFF surgery was successful in 28 cases. Six months after resection 28 patients reported satisfactory speech and swallowing. Two years after surgery, 92% (n=26) of patients resumed a normal diet. All patients underwent dental evaluation and 68% (n=19) of patients required dental rehabilitation over a post-operative period of 3-18 months. Patients self assessed their quality of life on a scale of 0-2. First year post-operatively, 21 patients reported a good quality of life (score=2). After the second year, 26 patients reported a good quality of life and the remaining two patients reported an intermediate quality of life (score=1) because they did not resume a normal diet. RFFF for palatal reconstruction is a reliable technique and provides a definitive separation between oral and sinusonasal cavities. Furthermore, it improves quality of life by improving speech, swallowing and chewing. It should be considered an integral component of head and neck cancer therapy and rehabilitation.

  5. Embolismo tumoral pulmonar microvascular en paciente con tumor urotelial

    Directory of Open Access Journals (Sweden)

    B. de Escalante Yangüela

    2015-08-01

    Full Text Available Los embolismos tumorales pulmonares (ETP representan una causa poco frecuente de disnea en pacientes oncológicos. La mayoría se diagnostican en pacientes con tumores avanzados, sobre todo localizados en mama, pulmón o estómago. Existen pocos casos publicados en pacientes con tumores uroteliales. Presentamos el caso de un varón de 69 años, sin diagnóstico previo de cáncer, que ingresó por disnea subaguda, con sospecha clínica inicial de tromboembolismo pulmonar (TEP. El paciente falleció al 5º día del ingreso. En la autopsia se comprobó la existencia de un tumor en pelvis renal izquierda con metástasis hepáticas y linfoganglionares múltiples y una extensa embolia pulmonar microvascular que afectaba a gran parte de los capilares y vasos sanguíneos de mediano calibre de ambos pulmones. Los ETP se consideraron responsables de la insuficiencia respiratoria progresiva y se interpretaron como la causa última de la muerte. La presentación clínica más frecuente de los ETP es la disnea, a menudo se confunden con el TEP y el diagnóstico no resulta fácil. Su pronóstico es muy malo, con una elevadísima mortalidad y su confirmación habitualmente es post-mortem.

  6. 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.

  7. Spontaneous Coronary Artery Dissection.

    Science.gov (United States)

    Tweet, Marysia S; Gulati, Rajiv; Hayes, Sharonne N

    2016-07-01

    Spontaneous coronary artery dissection is an important etiology of nonatherosclerotic acute coronary syndrome, myocardial infarction, and sudden death. Innovations in the catheterization laboratory including optical coherence tomography and intravascular ultrasound have enhanced the ability to visualize intimal disruption and intramural hematoma associated with SCAD. Formerly considered "rare," these technological advances and heightened awareness suggest that SCAD is more prevalent than prior estimates. SCAD is associated with female sex, young age, extreme emotional stress, or extreme exertion, pregnancy, and fibromuscular dysplasia. The clinical characteristics and management strategies of SCAD patients are different than for atherosclerotic heart disease and deserve specific consideration. This review will highlight recent discoveries about SCAD as well as describe current efforts to elucidate remaining gaps in knowledge.

  8. Depression and Coronary Heart Disease

    OpenAIRE

    2012-01-01

    There are exciting findings in the field of depression and coronary heart disease. Whether diagnosed or simply self-reported, depression continues to mark very high risk for a recurrent acute coronary syndrome or for death in patients with coronary heart disease. Many intriguing mechanisms have been posited to be implicated in the association between depression and heart disease, and randomized controlled trials of depression treatment are beginning to delineate the types of depression manage...

  9. Coronary heart disease

    Institute of Scientific and Technical Information of China (English)

    1992-01-01

    920658 Assessment of plasma catechola-mine and β-endorphin contents in patientswith silent myocardial ischemia and anginapectoris. WU Lin(吴林), et al. 1st Hosp, BeijingMed Univ, Beijing, 100034. Cbin J Cardiol1992; 20(2): 90-91. Thirteen Patients with totally silent myocar-dial ischemia(group 1)and 15 patients with ef-fort angina(group 2)were studied. The coronary

  10. Coronary pressure and flow relationships in humans: phasic analysis of normal and pathological vessels and the implications for stenosis assessment: a report from the Iberian–Dutch–English (IDEAL) collaborators

    Science.gov (United States)

    Nijjer, Sukhjinder S.; de Waard, Guus A.; Sen, Sayan; van de Hoef, Tim P.; Petraco, Ricardo; Echavarría-Pinto, Mauro; van Lavieren, Martijn A.; Meuwissen, Martijn; Danad, Ibrahim; Knaapen, Paul; Escaned, Javier; Piek, Jan J.; Davies, Justin E.; van Royen, Niels

    2016-01-01

    Background Our understanding of human coronary physiological behaviour is derived from animal models. We sought to describe physiological behaviour across a large collection of invasive pressure and flow velocity measurements, to provide a better understanding of the relationships between these physiological parameters and to evaluate the rationale for resting stenosis assessment. Methods and results Five hundred and sixty-seven simultaneous intracoronary pressure and flow velocity assessments from 301 patients were analysed for coronary flow velocity, trans-stenotic pressure gradient (TG), and microvascular resistance (MVR). Measurements were made during baseline and hyperaemic conditions. The whole cardiac cycle and the diastolic wave-free period were assessed. Stenoses were assessed according to fractional flow reserve (FFR) and quantitative coronary angiography DS%. With progressive worsening of stenoses, from unobstructed angiographic normal vessels to those with FFR ≤ 0.50, hyperaemic flow falls significantly from 45 to 19 cm/s, Ptrend stenosis severity and was consistent across all strata of stenosis (Ptrend > 0.05 for all). Trans-stenotic pressure gradient rose with stenosis severity for both rest and hyperaemic measures (Ptrend stenosis severity under resting conditions (Ptrend stenosis severity, TG rises. However, while hyperaemic flow falls significantly, resting coronary flow is maintained by compensatory reduction of MVR, demonstrating coronary auto-regulation. These data support the translation of coronary physiological concepts derived from animals to patients with coronary artery disease and furthermore, suggest that resting pressure indices can be used to detect the haemodynamic significance of coronary artery stenoses. PMID:26612582

  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. Methylene blue solder re-absorption in microvascular anastomoses

    Science.gov (United States)

    Birch, Jeremy F.; Hepplewhite, J.; Frier, Malcolm; Bell, Peter R. F.

    2003-06-01

    Soldered vascular anastomoses have been reported using several chromophores but little is known of the optimal conditions for microvascular anastomosis. There are some indications of the optimal protein contents of a solder, and the effects of methylene blue on anastomotic strength. The effects of varying laser power density in vivo have also been described, showing a high rate of thrombosis with laser power over 22.9Wcm-2. However no evidence exists to describe how long the solder remains at the site of the anastomosis. Oz et al reported that the fibrin used in their study had been almost completely removed by 90 days but without objective evidence of solder removal. In order to address the issue of solder re-absorption from the site of an anastomosis we used radio-labelled albumin (I-125) incorporated into methylene blue based solder. This was investigated in both the situation of the patent and thrombosed anastomosis with anastomoses formed at high and low power. Iodine-125 (half life: 60.2 days) was covalently bonded to porcine albumin and mixed with the solder solution. Radio-iodine has been used over many years to determine protein turnover using either I-125 or I-131. Iodine-125 labelled human albumin is regularly used as a radiopharmaceutical tool for the determination of plasma volume. Radio-iodine has the advantages of not affecting protein metabolism and the label is rapidly excreted after metabolic breakdown. Labelling with chromium (Cr-51) causes protein denaturation and is lost from the protein with time. Labelled albumin has been reported in human studies over a 21-day period, with similar results reported by Matthews. Most significantly McFarlane reported a different rate of catabolism of I-131 and I-125 over a 22-day period. The conclusion from this is that the rate of iodine clearance is a good indicator of protein catabolism. In parallel with the surgery a series of blank standards were prepared with a known mass of solder to correct for isotope

  13. Electrical cardioversion for atrial fibrillation improves microvascular flow independent of blood pressure changes.

    Science.gov (United States)

    Elbers, Paul W G; Prins, Wilhelmina B; Plokker, Herbert W M; van Dongen, Eric P A; van Iterson, Mat; Ince, Can

    2012-10-01

    This study tested the hypothesis that there is a discrepancy between global hemodynamic parameters and microvascular flow in patients before and after successful elective electrical cardioversion (ECV) for atrial fibrillation (AF). Prospective observational study. Preanesthesia holding area in a teaching hospital. Adult patients who underwent successful elective ECV for AF. ECV. Routine measurements of heart rate and noninvasive blood pressure were recorded and the sublingual microcirculation was visualized by sidestream darkfield imaging before and after the conversion of AF to sinus rhythm by elective ECV. The conversion to sinus rhythm significantly improved the microvascular flow index for smaller and larger microvessels. For smaller microvessels, perfused vessel density did not reach significance after conversion to sinus rhythm, whereas the proportion of perfused vessels was significantly larger and indices of heterogeneity for microvascular flow index decreased significantly. No correlation could be identified for the changes in mean blood pressure, perfused vessel density, and microvascular flow index for smaller microvessels. Successful ECV in patients with AF improves indices of sublingual microvascular perfusion. This change has no clear relation to the change in blood pressure and cannot be predicted from it. It may be prudent not to rely solely on global hemodynamic parameters to assess end-organ perfusion in this setting. Copyright © 2012 Elsevier Inc. All rights reserved.