[Show abstract][Hide abstract] ABSTRACT: Heart-type fatty acid-binding protein (H-FABP) is a novel cardiac marker used in the early diagnosis of acute myocardial infarction (AMI), which shows myocyte injury. Our study aimed to compare bedside H-FABP measurements with routine creatine kinase-MB (CK-MB) and troponin I (TnI) tests for the early diagnosis of non-ST-elevation MI (NSTEMI), as well as for determining its exclusion capacity.
A total of 48 patients admitted to the emergency room within the first 12 hours of onset of ischaemic-type chest pain lasting more than 30 minutes and who did not have ST-segment elevation on electrocardiography (ECG) were included in the study. Definite diagnoses of NSTEMI were made in 24 patients as a result of 24-hour follow up, and the remaining 24 patients did not develop MI.
When various subgroups were analysed according to admission times, H-FABP was found to be a better diagnostic marker compared to CK-MB and TnI (accuracy index 85%), with a high sensitivity (79%) and specificity (93%) for early diagnosis ( ≤ six hours). The respective sensitivities of bedside H-FABP and TnI tests were 89 vs 33% (p < 0.05) for patients presenting within three hours of onset of symptoms.
Bedside H-FABP measurements may contribute to correct early diagnoses, as its levels are elevated soon following MI, and measurement is easy, with a rapid result.
[Show abstract][Hide abstract] ABSTRACT: Mucopolysaccharidosis type IV B (MPS IV B), also known as Morquio syndrome, is a rare inherited disease from a group of lysosomal storage disorders. Estimates of birth prevalence range from less than 1/40,000 to 1/200,000 births. MPS IV B occurs because of a deficiency of the enzyme beta-galactosidase. A deficiency of this enzyme leads to the accumulation of mucopolysaccharides in the whole body with e.g. growth retardation, a prominent lower face, an abnormally short neck, kyphoscoliosis, abnormal and/or a prominent breast bone (pectus carinatum). Also cardiomegaly may also occur. The accumulation in cardiomyocytes causes progressive damage to cells, tissues, and failure of their function. Cardiac manifestation could cause a premature death of the patient.
Our clinical case report shows a 60-year old women with symptomatic aortic valve stenosis and severe hypertrophy of the left ventricle. From the childhood there raised suspicion of lysosomal storage disorder because of her clinical features. She had signs of enzymatic storage disorders (as growth retardation with height 140 cm in adulthood, abnormally short neck, kyphoscoliosis, abnormalities of foot and legs, pectus carinatum). The diagnosis of MPS IV, type B in our patient was confirmed by enzyme and genetic screening. The patient suffered from mild dyspnea (NYHA class II), patient's sister, also with MPS IV, died from sudden cardiac death at her 60.
By echocardiographic examination there was significant aortic valve stenosis, with progression during 2 years follow up (AVA 0,67cm2, AVAi 0,45 cm2/m2,PG mean 75 mmHg) and asymetric septal hypertrophy with mild left ventricle outflow tract obstruction at rest. There was no coronary artery disease. MRI of cervical spine showed severe C2/C3 spinal stenosis with special need of perioperative anaesthesiologic care. Aortic valve replacement and septal myectomy were performed without any complications, also postoperative period is so far without any complications. The patient is free of symptoms. Histological examination of the aortic valve tissue and myocytes confirmed also lysosomal storage.
Conclusions: Mucopolysaccharidosis type IV B with this combination of cardiac manifestation (severe valve disease and septal hypertrophy with LVOT obstruction) has not been published yet. Cardiologic and echocardiographic assessment should be completed at the time of diagnosis and according to the clinical course at least every 1–2 years thereafter by patients with MPS IV. Cardiac surgery with very careful perioperative monitoring seems to be safe and effective.
No preview · Article · Dec 2014 · European Heart Journal – Cardiovascular Imaging
[Show abstract][Hide abstract] ABSTRACT: Coronary artery fistulas (CAF) are a rare cardiac anomaly that can be either congenital or acquired. CAFs have clinical significance because of complications such as dyspnea on exertion, congestive heart failure, and cardiac tamponade. The literature also contains case reports of CAF presenting as bacterial endocarditis. We describe a 31-year-old man who presented with native valve infective endocarditis related to an unusual form of a CAF between the circumflex coronary artery and left ventricle. He also had giant coronary arteries, which were imaged with computed tomography angiography and transesophageal echocardiography. The diameter of the circumflex coronary artery and left main coronary artery was measured as 19 mm. Surgical intervention for heart valves was performed because of vegetations resistant to continued antibiotic treatment. At the same time, the CAF was treated with surgery.
No preview · Article · Nov 2014 · Echocardiography
[Show abstract][Hide abstract] ABSTRACT: Whether there is any particular role of hypertension in remodeling process has not been completely understood yet. The aim of this study was to assess the association between hypertension and remodeling patterns in normal or minimally atherosclerotic coronary arteries. Seventy-nine patients who were free of significant coronary atherosclerosis were divided into two groups according to the absence (n = 39) or presence (n = 40) of hypertension; and standard intravascular ultrasound examination was performed in 145 segments. To determine the remodeling pattern in early atherosclerotic process, patients were also analyzed according to the level of plaque burden at the lesion site after the analysis of remodeling patterns. Positive remodeling was more prevalent in the hypertensive group (52.5% vs. 12.8%; P < .001) whereas negative remodeling was more common in diabetic patients (53.6% vs. 27.4%; P = .03). Mean remodeling index was 1.04 for hypertensives and 0.96 for normotensives (P = .03). There were no correlations between remodeling patterns and other risk factors such as age, family history, and hypercholesterolemia. Early atherosclerotic lesions (<30%) exhibited more negative remodeling characteristics while intermediate pattern was observed more frequently in patients with high plaque burden (P = .006 and .02, respectively). Positive remodeling showed no association in this context (P = .07). This study demonstrated that minimal atherosclerotic lesions in hypertensives had a tendency for compensatory arterial enlargement. Positive remodeling may result from local adaptive processes within vessel wall or hemodynamic effects of blood pressure itself.
No preview · Article · Apr 2012 · Clinical and Experimental Hypertension
[Show abstract][Hide abstract] ABSTRACT: We aimed to examine whether intracoronary high-dose bolus of tirofiban plus maintenance would result in improved clinical outcome in STEMI patients undergoing primary PCI in this pilot trial. A total of 56 patients were enrolled to receive either intracoronary high-dose bolus plus maintenance (n = 34) or intravenous high-dose bolus plus maintenance (n = 22) of tirofiban. Pre and post intervention TIMI flow grades, myocardial blush grades, peak CKMB and troponin levels, time to peak CKMB and troponin, time to 50% ST resolution and major composite adverse cardiac event rates at 30 days were recorded. Although incidence of major adverse cardiac events was not different, post intervention TIMI flow and TIMI blush grades, peak CKMB and troponin levels, and time to peak CKMB and time to peak troponin were significantly different, favoring intracoronary strategy. In conclusion, this regimen improved myocardial reperfusion and coronary flow, and reduced myocardial necrosis, but failed to improve clinical outcomes at 30 days.
Full-text · Article · Jan 2012 · Journal of Thrombosis and Thrombolysis
[Show abstract][Hide abstract] ABSTRACT: Inflammation plays an important role in the pathophysiology of atherosclerosis. Some studies suggest a link between chronic infections, an inflammatory state, and endothelial dysfunction. However, data related to acute infections are scant. We have investigated: (i) the effect of acute infection on endothelial function; (ii) the role of potential mediators of endothelial dysfunction.
Forty patients 40 years old with acute infection (mean age 53.9 +/- 8.8 years), without coronary artery disease or its equivalents were enrolled. Endothelial function and blood levels of high sensitive C-reactive protein, interleukin-6, tumour necrosis factor-a, high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), apolipoprotein-A1 (Apo-A1) and apolipoprotein-B100 (Apo-B100) were assessed in the acute infection phase and 1 month after recovery. Endothelial function was evaluated by brachial artery flow-mediated vasodilation (FMD).
The intraclass correlation coefficients for intra- and interobserver agreement for FMD measurements were 0.98 (95% CI: 0.95-0.99) and 0.93 (95% CI: 0.83-0.97), respectively. FMD improved significantly 1 month after recovery (P < 0.001). Compared to the levels at 1 month, inflammatory markers, LDL cholesterol, LDL/HDL ratio, Apo-B100 and Apo-B100/Apo-A1 ratio were significantly higher. However, HDL and apo-A1 were significantly lower in the phase of acute infection. Change in FMD from baseline to 1 month after recovery correlated significantly only with the change in Apo-A1 (r = 0.35, P = 0.027).
Acute infection causes transient endothelial dysfunction. It increases inflammatory markers and generates an atherogenic lipid profile. Among the parameters evaluated, only the change in Apo-A1 level was associated with acute infection-induced endothelial dysfunction.
Full-text · Article · Oct 2011 · Acta cardiologica
[Show abstract][Hide abstract] ABSTRACT: Hypertrophic cardiomyopathy (HCM) is characterized by disorganized myocardial architecture, and may cause ventricular arrhythmias and sudden death. The angiotensin-converting enzyme (ACE) with two deletion alleles (DD genotype) has been proposed to be associated with increased myocardial collagen content. We evaluated QT dispersion (QTd), which reflects regional differences in ventricular repolarization, in HCM patient and controls among the three different ACE genotypes.
Sixty-three patients with HCM and 20 healthy subjects were included in the study. QT parameters were measured from 12 lead electrocardiograms. ACE genotypes were determined from the DNA extracted from peripheral blood by a polymerase chain reaction (PCR) method. QT parameters were compared among the three ACE genotypes both in HCM patients and controls.
Median ages were similar in HCM and control groups. QTd and corrected QTd (QTcd) were significantly greater in the HCM group compared with the controls. The frequencies of each genotype were similar in both groups. Although QTd and QTcd did not differ among the three genotypes in the control subjects, they were significantly greater in patients with DD genotype compared with other genotypes in the HCM group.
QTd and QTcd are increased in patients with HCM, especially in those with the DD genotype.
Full-text · Article · Sep 2010 · Journal of Renin-Angiotensin-Aldosterone System
[Show abstract][Hide abstract] ABSTRACT: We aimed to identify characteristics differentiating patients undergoing mitral valve replacement versus valve repair for mitral regurgitation (MR) and to investigate retrospectively mid-term clinical and functional outcomes.
From January, 2004 to January, 2009 146 patients underwent mitral valve surgery (62 male / 84 female; age: 55.9+/-13.6 [18-80] years) by one surgical team. Mitral valve replacement was performed in 101 patients (69.2 %) and valve repair was performed in 45 patients (30.8%). Mean follow-up time was 586+/-413 days. Life tables were constructed for the analysis of 5-year complication free survival and comparisons were performed between the groups using Log-rank test within 95%CI.
The choice of surgical technique depended on the etiology of MR. Degenerative (p=0.001) and ischemic (p=0.014) MR were more common in patients undergoing repair whereas patients with complex rheumatic mitral valve disease (p=0.001) with subvalvular involvement commonly underwent replacement. Overall 30-day mortality was 3.2% (replacement, 3.96%vs repair, 2.22%, p=0.59). Although there was no significant difference between the groups regarding baseline left ventricular ejection fraction (EF) (ischemic p=0.61; non-ischemic p=0.34), improvement was more pronounced in the repair group for both etiologies (ischemic MR, p=0.001; non- ischemic MR p=0.002). Survival at 5-years was 91.7+/-4.7% after repair and 83.5+/-9.2% after replacement, respectively (p=0.83). Freedom from grade 2 or more mitral regurgitation, reoperation, endocarditis, and thromboembolism were 95+/-5% vs 97+/-3% (p=0.71); 95+/-4% vs 98+/-2% (p=0.98); 94+/-4% vs 100% (p=0.16); and 85+/-8% vs 100% (p=0.095) in replacement and repair groups, respectively.
This study demonstrates that mitral valve repair is associated with an acceptable operative mortality, satisfactory mid-term survival and better preservation of left ventricular function. Significant differences in favor of repair are expected in long-term follow-up particularly regarding freedom from thromboembolism and endocarditis.
No preview · Article · Aug 2010 · Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology
[Show abstract][Hide abstract] ABSTRACT: Objective: Cell therapy for patients with ischaemic cardiomyopathy (IC) is still an open issue. We aimed to assess the long-term safety and therapeutic potency of autologous bone marrow mononuclear cell (ABMMNC) implantation into ungraftable coronary artery (UCA) territories in patients with IC. Methods: Bone marrow was aspirated from the iliac crest, and transepicardial ABMMNC implantation (n = 25, 24 men, aged 57 ± 7 years) as an adjunct to coronary artery bypass grafting (CABG) was performed into an area of reversible ischaemia within the territory of UCA (1.29 ± 0.09 × 109 ABMMNCs). Control group (n = 25, 23 men, aged 59 ± 7 years) underwent incomplete CABG due to poor target vessel graftability. The study protocol consisted of coronary angiography, stress echocardiography, nuclear imaging and Holter monitoring at baseline and follow-up. The mean follow-up time was 988 ± 423 days. Results: There was no difference between the groups regarding postoperative complications and outcome. Overall 5-year survival for the ABMMNC group was 79 ± 10%, and 71 ± 12% for the controls (p = 0.48). Left ventricular ejection fraction (LVEF) at baseline was 24.8 ± 3.7 versus 25.9 ± 3.1 in the ABMMNC group and the controls, respectively. After 6 months, mean global LVEF increased to 36.3 ± 7.4 (p < 0.001) versus 31.4 ± 4.1 (p = 0.001), respectively. A significant difference was noted in delta LVEF between the groups (p < 0.001, 95% confidence interval (CI): 3.4–8.9) at 6 months, and (p = 0.001, 95% CI: 2.0–7.4) at 1 year. Accordingly, perfusion scores in UCA segments detected by single-photon emission computed tomography (SPECT) improved with ABMMNC therapy to 18.0 ± 24.4 from 7.1 ± 25.7 (p = 0.001 vs control UCA segments). Conclusion: Cellular therapy for IC within UCA could augment myocardial perfusion and contractility but does not improve overall survival. No adverse events were detected after cell therapy at mid-term follow-up.
Full-text · Article · Oct 2009 · European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: To determine whether subcutaneous administration of nitroglycerin mixed with local anesthetic agent results in effective vasodilation of the radial artery, and whether this technique improves access time and decreases complications.
This prospective study consisted of two consecutive investigations. In the first (n = 30), only local anesthetic agent (prilocaine 2%) was injected into one arm, and local anesthetic agent plus 500 microg nitroglycerin was injected into the other arm. Radial artery diameters before and after injections were measured by ultrasonography. In the second, 33 patients received local anesthetic agent (prilocaine 2%) plus 500 microg nitroglycerin (group A) and 30 received only local anesthetic agent (group B) to determine whether the addition of nitroglycerin would improve radial artery access time, duration of angiography, perception of arterial pulse (ie, pulse score), number of punctures before successful cannulation, and complication rates.
In the first investigation, radial artery diameter increased significantly in the nitroglycerin-treated arm (2.3 mm +/- 0.4 vs 2.9 mm +/- 0.5; P = .05). In the second, there were no significant differences between groups with respect to age, sex, duration of angiography, and number of punctures before cannulation. However, the pulse score increased and radial artery access time improved significantly after addition of nitroglycerin (79% vs 10% [P < .001] and 75 sec +/- 47 vs 132 sec +/- 100 [P = .005], respectively). Radial artery spasm and thrombosis were less frequently observed in group A, albeit to an insignificant extent (P = .39 and P = .49, respectively).
Subcutaneous administration of nitroglycerin significantly increased radial artery diameter, which can lead to facilitation of catheterization of the radial artery for arteriography and interventions.
Full-text · Article · Jul 2009 · Journal of vascular and interventional radiology: JVIR
[Show abstract][Hide abstract] ABSTRACT: There are few data on the change in the profile of cath lab patients over long time intervals.
We retrospectively analysed our cath lab records, patient charts, in terms of demographic variables, clinical and laboratory characteristics in a thousand patients (499 patients in 1998 January-March, 501 patients in 2006 January-March).
Mean age was significantly higher in the 2006 cohort (57.5 +/- 11 vs. 62.2 +/- 10.8, P < 0.001). Gender was similar in both cohorts (men 68.5% vs. women 69.9%, P = 0.65). Both hypertension and diabetes mellitus were more prevalent in the 2006 cohort (613% vs. 49.3 and 30.3 vs. 17.6 respectively, P < 0.001 for both). Smoking rates (past or active) did not differ between the cohorts. Rates of normal or near normal coronary angiograms were somewhat elevated in both cohorts (36.7% in 1998 and 39.1% in 2006). Rates of multivessel disease (2-3 vessel disease) tended to increase and rates of single-vessel disease tended to decrease from the 1998 cohort to the 2006 cohort (27.7% to 34.4% and 35.7% to 26.7%, P = 0.006). The number of percutaneous coronary interventions (PCI) performed increased with a borderline statistical significance in the 2006 cohort (32% vs. 38.5%, P = 0.053).
Our data indicates that today interventional cardiologists face an older and more severely diseased cath lab patient population compared with a decade earlier. In comparison with 1998, more PCIs were performed.
Full-text · Article · Mar 2009 · Acta cardiologica
[Show abstract][Hide abstract] ABSTRACT: We present three cases of septic pulmonary embolism which occurred as a result of three different causes. The first case, was a 23 year old woman suffering from cough, sputum, hemopthisis and pleuritic chest pain. She had a right subclavian port. On her thorax computed tomography (CT) scans there were widespread bilateral, irregular parenchymal nodular infiltrates and some of them beginning to cavitate. Meticilin resistant stafilococus aureus (MRSA) was isolated from the blood culture and septic embolism was diagnosed. A month after antibiotic theraphy her parenchymal nodules have considerably decreased in size. The second case was a 40 year old woman admitted to our hospital with the same complaints. Her radiological findings were similar. Meticilin sensitive stafilococus aureus (MSSA) was isolated from the blood cultures and antibiotic theraphy was initiated. To investigate the etiology of the nodules due to septic embolism, echocardiography was performed and infective endocarditis was diagnosed. After the antibiotic theraphy and a tricuspid valve operation her parenchymal nodules disappeared. The final case involved a 51 year old man suffering from fever, fatigue, cough and pain in the left arm for one week. His general status was bad. His radiological findings were also similar to the others. Staphillococcus aureus was isolated from blood and wound culture. Following clinical and radiological findings we thought it was a case of septic pulmonary embolism and antibiotic theraphy was started. Despite the therapy we did not take fever response and he died five days after antibiotic therapy. In conclusion, septic pulmonary embolism should be considered in bilateral cavitary nodular infiltrates and must be managed fast.
Full-text · Article · Jul 2008 · Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo
[Show abstract][Hide abstract] ABSTRACT: Aspirin and angiotensin converting enzyme (ACE) inhibitors both have beneficial effects on prognosis in patients with cardiovascular disease. For this reason, they are usually prescribed together. Some of the beneficial effects of ACE inhibitors are thought to be due to reduced degradation of bradykinin. Bradykinin enhances nitric oxide and vasodilatory prostaglandins. Theoretically, aspirin, which inhibits cyclooxygenase enzyme, may reduce bradykinin mediated prostaglandin synthesis and blunt the beneficial effects of ACE inhibitors, when used together. Although some hemodynamic studies support this hypothesis, clinical studies have conflicting results. In this article, we reviewed the possible interaction between aspirin and ACE inhibitors in light of literature findings.
No preview · Article · Jan 2008 · Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology
[Show abstract][Hide abstract] ABSTRACT: Pacemaker and implantable cardioverter defibrillator (ICD) implantation increases cardiac troponin I (cTnI) levels which indicates myocardial injury. During implantation of a cardiac resynchronization therapy (CRT) device, balloon inflation for coronary sinus (CS) venogram, cannulation of CS side branch, and electrode advancement may interfere with CS drainage and, hence, may decrease the washout of toxic metabolites from the heart. Thus, CRT implantation may further increase cTnI levels. In this study, we investigated the effects of CRT implantation on cTnI release.
We included 10 patients (mean age = 57 +/- 15 years) in whom a successful transvenous CRT system was implanted (CRT group). Twenty patients (mean age = 65 +/- 10 years) who underwent a transvenous pacemaker or ICD implantation were included as the control group. Blood samples for cTnI were drawn at baseline and at six, 12, 18, and 24 hours thereafter.
Baseline median cTnI levels were similar in CRT and control groups (0.03 ng/mL vs 0.02 ng/mL, respectively; P = 0.1). Postoperative cTnI levels during 24 hours were significantly higher in the CRT group (P < 0.05) by two-way repeated measures of analysis of variance. Post hoc analysis revealed that cTnI levels were higher at the 6th, 12th, 18th, and 24th hours compared to baseline levels (P < 0.001, P < 0.001, P < 0.01, and P < 0.01, respectively). There was a significant difference in the area under the curves (AUCs) of cTnI measurements (1.79 hr.ng/mL in the CRT group and 0.78 hr.ng/mL in the control group, P < 0.05).
Postoperative cTnI levels were higher after CRT implantation than simple pacemaker/ICD implantation. This may be due to CS manipulation during CRT implantation.
No preview · Article · Nov 2007 · Pacing and Clinical Electrophysiology
[Show abstract][Hide abstract] ABSTRACT: The authors undertook this study to see whether highly developed coronary collaterals at an area shed by a totally occluded coronary artery predicts myocardial viability. Percutaneous coronary intervention (PCI) of a totally occluded coronary artery has been debated since its introduction. It is recommended to search for viable myocardium before opening a totally occluded coronary artery; however, there is no practical yet sensitive method of assessing myocardial viability in the catheterization laboratory. Forty-seven consecutive patients (12 women, 25.5%; 35 men, 74.5%), each with 1 totally occluded coronary artery, were prospectively enrolled to the study. After the diagnostic coronary angiography, all patients underwent dobutamine stress echocardiography to determine viable myocardium at the territory of the totally occluded coronary artery, and the status of angiographic coronary collaterals was assessed. Patients were then divided into 2 groups according to the presence (Group A) or absence (Group B) of viable myocardium by stress echocardiography. Eighteen patients (38.3%) had viable myocardium (Group A) in the area shed by the totally occluded coronary artery and 29 patients (61.7%) had nonviable myocardium (Group B). The incidences of significant coronary collateral circulation to the viable (Group A) and nonviable (Group B) areas were 66.7% (12 patients) and 20.7% (6 patients), respectively (p = 0.002). Logistic regression analysis was used to evaluate the independent factors for viable myocardium, and only significant coronary collateral circulation was found to be an independent factor for the detection of viable myocardium (p = 0.006, OR 16.7, 95% CI 2.25 to 124.4). The sensitivity and specificity of good collateral circulation for the detection of viable myocardium were 75% and 65.7%, respectively. The positive predictive and negative predictive values of the good coronary collateral circulation in detecting viable myocardium were 75% and 79%, respectively. The authors conclude that good coronary collaterals have a high sensitivity and positive predictive value for the prediction of viability as shown by dobutamine echocardiography, and only by assessing the coronary collateral circulation can one decide for percutaneous coronary revascularization, if not for coronary artery bypass surgery.
[Show abstract][Hide abstract] ABSTRACT: This study was to test safety and efficacy of 1:1 mixture of gadolinium:nonionic contrast media in avoiding contrast nephropathy during coronary angiography in patients with renal dysfunction. Although "off label" for x-ray angiography, gadolinium has drawn attention for its potential to avoid contrast nephropathy during coronary angiography. Initial data seem promising. Patients with a baseline creatinine of 1.5 mg/dl or more were included. In order to minimize contrast nephropathy risk, all patients were thoroughly hydrated and treated by N-acetylcysteine. After coronary angiography and/or percutaneous coronary intervention, renal function tests were remeasured on days 1, 2, and 3. A rise of 0.5 mg/dl or more in creatinine value in the following 3 days or the need for dialysis were considered as a contrast nephropathy event. Twenty-six patients were enrolled in this study. Ten were women and 16 were men. The mean age was 65.7 +/- 11. Baseline creatinine value was 2.47 +/- 0.74 mg/dl. The total amount of contrast medium used on 1:1 fashion was 57.1 +/- 27.2 ml. No procedure-related cardiac complication or contrast nephropathy event occurred in this study. Although there was a slight loss in image quality, we felt that the results were adequate for interpretation. Although "off label," using gadolinium contrast media in a 1:1 mixture with standard nonionic low osmolar contrast media seems to be a viable option in decreasing the likelihood of contrast nephropathy. Further evaluation appears to be warranted.
[Show abstract][Hide abstract] ABSTRACT: Angiotensin II induces various growth factors such as vascular endothelial growth factor, platelet-derived growth factor, and fibroblast growth factor, and recent studies suggest that the expression of these growth factors promotes collateral growth. We hypothesized that the blockage of angiotensin II production by ACE inhibitors might interfere with collateral development in patients with coronary occlusion.
The study group consisted of 187 patients (114 males, mean ages, 62 +/- 11 years) who had chronic (> 1 month) coronary occlusion (TIMI flow grade < or = 1) in one of 3 epicardial coronary arteries. Collaterals were graded using the Rentrop classification, and the patients were divided into 2 groups according to having good (grade 2 and 3) or poor (grade 0 and 1) collaterals (n = 127 and 60, respectively). Clinical and angiographic characteristics were compared in the 2 groups.
ACE inhibitor use (52% versus 35%, P = 0.04) and the prevalence of diabetes mellitus (DM) (43% versus 27%, P = 0.02) was higher in patients with poor collaterals. Patients with poor collaterals had a higher frequency of circumflex artery (Cx) occlusion, worse wall motion, and lower ejection fraction. In multivariate analysis, ACE inhibitor use (OR: 2.4; 95% CI = 1.23-4.68, P = 0.01) and the occlusion of Cx (OR: 3.3, 95% CI; 1.33-8.12, P = 0.01) were found to be independent predictors for poor collateral development, whereas there was a trend for DM as a predictor for poor collaterals (OR: 1.9, 95% CI = 0.97-3.8, P = 0.06).
The findings suggest that ACE inhibitor therapy may contribute to poor collateral development in patients with coronary occlusion.
No preview · Article · Aug 2007 · International Heart Journal