International journal of cardiology. Heart & vessels最新文献

Background

Aortic elastic properties are determinants of left ventricular function by means of ventriculo-arterial coupling and indicators of cardiovascular risk. Aortic valve stenosis surgical replacement temporary reduces aortic function damaging vasa vasorum, while transcatheter aortic valve implantation (TAVI) does not influence it in the short term. We studied aortic distensibility, stiffness, M-mode strain and tissue strain after 6 and 12 months from TAVI.

Methods

We enrolled 15 patients with symptomatic severe aortic stenosis who underwent CoreValve prosthesis (Medtronic, Minneapolis, MN) implantation. Everyone had blood pressure measurement and echocardiography registration before TAVI and after 6 and 12 months.

Results

After TAVI NYHA class (p = 0.016), peak and mean aortic valve gradients (p < 0.001 for both) improved. Aortic distensibility increased (p = 0.032 in the first 6 months, p = 0.005 in the second 6 months, and p = 0.003 from baseline to 12 months), as well as stiffness decreased (p = 0.034; 0.090; 0.001), M-mode strain and tissue strain ameliorated (p = 0.041; 0.004; 0.004; and p = 0.013; 0.002; 0.001, respectively), tissue Doppler imaging improved (S′ wave: p = 0.289; 0.347; 0.018. E′ wave: p = 0.018; 0.113; 0.007. A′ wave: p = 0.002; 0.532; 0.001). Moreover, some left ventricular parameters improved at 6 months, such as ejection fraction (from 49 ± 16 to 57 ± 11%; p = 0.044) and diastolic interventricular septum thickness (from 14 ± 2 to 12 ± 2 mm; p = 0.010). Even systolic pulmonary artery pressure (p = 0.019) and left diastolic dysfunction grade ameliorated (p = 0.042).

Conclusions

For the first time we demonstrated that aortic elastic properties improve at 6 and 12 months after TAVI, thus influencing ventriculo-arterial coupling and ameliorating left ventricular function.

Background

There have been no previous reports that apolipoprotein (apo) A-I mimetic peptide improves survival rate after myocardial infarction (MI).

Method and results

Male C57Bl/6J mice were subjected to left coronary artery permanent ligation as a model of MI. We synthesized a novel 24-amino acid apoA-I mimetic peptide-type5 (FAMP5), which potently removes cholesterol via specific ATP-binding cassette transporter A1 (ABCA1). FAMP5 was associated with a significantly improved survival rate by protecting against cardiac rupture compared to the control. mRNA levels for eNOS, Gata-4, CTGF and ANP were significantly increased in the hearts of the FAMP5-treated group, while that for MCP-1 decreased.

Conclusion

This is the first report that high-density lipoprotein (HDL) therapy with FAMP5 improved the survival rate after MI.

Factors such as aging, atherosclerosis, hypertension, genetic defects and diabetes mellitus have been known to cause arteries to develop various shapes and characteristics in patients such as tortuosity, kinking, twisting, elongation, contraction, and curving. The change in artery mechanics can cause a variety of cardiovascular diseases among men and women. The improvement in technology and techniques has allowed access to different therapies such as balloon angioplasty or stenting. Stents are permanent implants that undergo repetitive deformations as a result of patient daily activities such as walking, flexing, sitting, climbing stairs, and getting into a car. Often, these deformations imposed on the stents result in stent failures. It is imperative that the biomechanics environment of the arteries causing stent failure is well understood and the stents be evaluated under multiple loading modes for increased life-cycle. As a result, this paper aims to summarize part of the available literature that reports studies on biomechanical environment in healthy and diseased arteries using various analytical methods.

Background

Time–frequency analysis of the electrocardiographic QRS complex (QRS) has not been uniformly accepted. We investigated this new method of analysis and evaluated its clinical significance in patients with ischemic cardiomyopathy (ICM) and with myocardial infarction (MI).

Methods

The study population included 71 consecutive patients with MI, 32 with ICM, and 40 healthy individuals. We recorded 12-lead electrocardiograms through a band pass filter (0.15–300 Hz) and applied a continuous wavelet transform (CWT) to measure the time–frequency power within the QRS in leads V₁ or II. Integrated time–frequency power (ITFP) between QRS complexes was measured to quantify the wavelet-transformed ECG signals (WT-ECG signal), which were classified into three frequency zones: low-frequency QRS (LF-QRS, 5–15 Hz), mid-frequency QRS (MF-QRS, 15–80 Hz) and high-frequency (HF-QRS, 150–250 Hz). In addition, we explored the relationship between the frequency power within the QRS and the density of fibroblasts using a computer simulation.

Results

The ITFP values were lower in MF-QRS band in patients with anterior or inferior MI, but were significantly greater in LF-QRS and HF-QRS bands of ICM patients than in other groups. In the simulation study, the ITFP values from pseudo-QRS increased in the HF and LF zones if the fibroblast–myocyte ratio (r) was between 1.0 and 2.5.

Conclusions

The QRS frequency profile was characterized by an increase in HF-QRS in ICM, which might be due to the generation of micro-fibrous tissues in local areas of the cardiac ventricles.

The majority of patients with acute coronary syndrome (ACS) are elderly. Limited evidence makes decision-making on the use of percutaneous coronary intervention (PCI) mainly empirical. Old age is one risk factor, but other factors than age may have an impact on mortality as well. Therefore, we investigated predictors of long-term all-cause mortality among octogenarians who have undergone PCI due to ACS. A total of 182 patients ≥ 80 years who underwent PCI during 2006–2007 at Sahlgrenska University Hospital were studied consecutively from recorded clinical data. All-cause five-year mortality of follow-up was 46.2%. Mean age was 83.7 ± 2.8, 62% were male, 76% were in sinus rhythm, and 42% had left ventricular ejection fraction < 45%. Indications for PCI were STEMI (52%), NSTEMI (36%) and unstable angina (11%). Multivariate analysis in two steps identified atrial fibrillation, moderate tricuspid valve regurgitation, moderate mitral valve regurgitation, dependency in ADL and eGFR ≤ 30 ml/min at the first step and moderate mitral valve regurgitation, atrial fibrillation and eGFR ≤ 30 ml/min at the last step, as independent predictors of all-cause mortality. Kaplan Meier analysis of positive parameters from both steps of multivariate analysis showed high significant difference in survival between patients having these parameters and those who were free from these parameters, with worst prognosis in patients with accumulation of these parameters. Accordingly, we have, in an octogenarian patient cohort who suffered from ACS, undergone PCI in daily clinical practice, identified five prognostic predictors for all-cause death after five years' follow-up.

Background/Objectives

The association between electrocardiographic abnormalities and the outcomes in acute ischemic stroke patients after intravenous thrombolysis remains unclear. We sought to assess the predictive value of electrocardiographic abnormalities in stroke patients after thrombolysis.

Methods

Consecutive acute stroke patients with thrombolysis from Feb 2008 to Jun 2013 were included. Electrocardiographic abnormalities during hospitalization were retrospectively reviewed. Outcomes were 90-day modified Rankin's Score. Multivariate logistic regression was used to analyze the association of electrocardiographic abnormalities with 90-day outcome.

Results

From Feb 2008 to Jun 2013, 95 acute stroke patients (median age of 67 and 64.2% male) with electrocardiographic before/after thrombolysis and 90 day modified Rankin's Score were recruited in our study. Increased age (p = 0.027), higher baseline National Institutes of Health Stroke Scale (p < 0.001) and T-wave changes (p = 0.030) were significantly associated with worse functional outcome. T-wave changes (odds ratio 5.54, 95% confidence interval 1.37–22.37, p = 0.016) were independently associated with unfavorable outcome.

Conclusions

T-wave changes can be useful markers to predict the outcome in stroke patients after thrombolysis.

Background

We retrospectively studied the impact of the introduction of new P2Y12 inhibitors (prasugrel, ticagrelor) on platelet reactivity and clinical outcomes after Acute Coronary Syndrome (ACS) from a large single center registry.

Methods

Consecutive patients admitted for ACS since 2007 and discharged on dual antiplatelet therapy were enrolled. Biological response was assessed one month after discharge by PRI VASP and ADP-induced aggregation (%ADP). Patients were classified according to PRI VASP as very low on-treatment platelet reactivity (VLTPR) (PRI VASP ≤ 10%), low on-treatment platelet reactivity (LTPR) (PRI VASP ≤ 20%) and high on-treatment platelet reactivity HTPR (PRI VASP > 50%). Ischemic and bleeding complications were reported.

Results

1999 patients were analyzed, 605 before (July 2007–February 2010) and 1394 after introduction of new P2Y12 blockers (February 2010–August 2013). After introduction, we reported a significant lower PRI VASP values (38% ± 0.53 vs. 42% ± 0.81 p = 0.001), %ADP aggregation (52% ± 0.4 vs. 54% ± 0.6 p = 0.03) and HTPR incidence (22% versus 34% OR [95% CI]:0.65 [0.53–0.80]; p < 0.001). Conversely, incidence of VLTPR and LTPR were significantly higher after the introduction of new P2Y12 inhibitors: 6% versus 3% (OR [95% CI]: 2.0 [1.2–3.3]; p < 0.01) and 19% versus 8% (OR [95% CI]: 2.8 [2.0–3.9]; p < 0.001) respectively. Clinical follow-up confirmed biological findings with higher incidence of bleeding 10% versus 5% (OR [95% CI]: 2.1 [1.4–3.2]; p < 0.01) and lower incidence of stent thrombosis 1.3% versus 3.3% (OR [95% CI]: 0.39 [0.20–0.73]; p < 0.01) with new P2Y12 blockers.

Conclusion

The introduction of new P2Y12 inhibitors modified both platelet reactivity and clinical outcome of ACS patients, with higher rate of hyper responders and bleedings, and lower rate of non responders and thrombotic events.