2004 Vol. 1, No. 1
Inflammation is an important component of active atherosclerotic disease. C-reactive protein (CRP) is a non-specific inflammatory marker that is increased in inflammatory conditions. Newer more sensitive assays (high sensitivity CRP) can detect the low levels of inflammation associated with vascular disease. CRP levels can give further risk assessment to individuals beyond predictions from traditional risk factors. This measurement is most useful in helping to discriminate risk in intermediate risk patients such as metabolic syndrome patients. Exercise and weight loss have been shown to significantly lower CRP levels. Lipid lowering therapies, especially with the statin class of medications, also lower CRP levels. A reduction in inflammation may be an important component of plaque stabilization and contribute to cardiovascular risk reduction
Heart failure (HF) is a common disease associated with increasing age. B-type natriuretic peptide (BNP), is a cardiac neurohormone, and is released as prepro BNP and then enzymatically cleaved to the N-terminal-proBNP (NT-proBNP) and BNP upon ventricular myocyte stretch. Blood measurements of BNP have been used to identify patients with HF. The BNP assay is currently used as a diagnostic and prognostic aid in HF. In general, a BNP level below 100 pg/mL excludes acutely decompensated HF and levels > 500 pg/ml indicate decompensation. Recombinant human BNP (hBNP, nesiritide) is an approved intravenous treatment for acute, decompensated HF. Nesiritide given in supraphysiologic doses causes vasodilation, natriuresis, diuresis, and improved symptoms over the course of a 48-hour infusion. This paper will sort out the literature concerning the use of this peptide both as a diagnostic test and as an intravenous therapy.
To investigate the safety and efficacy of a 3-pulmonary vein (PV) isolation approach in treating paroxysmal atrial fibrillation (AF). Methods Radiofrequency catheter ablation was used to eliminate PV potential in 11 patients with frequent paroxysmal AF refractory to anti-arrhythmic agents. During sinus rhythm, PV potential was mapped in the left and right superior PVs and left inferior PV. The procedural success was defined as the elimination of PV potential in the 3 PVs. Results PV potential was identified and abolished in a total of 24 PVs, mostly in the left and right superior PV. There was no pulmonary stenosis or other complications during or after the procedures. AF recurred in one patient after an average of 12 ± 3 month follow-up. Conclusions PV potentials were present mostly in the left or right superior PV. The 3-PVs isolation approach is safe and effective in preventing drug-resistant paroxysmal AF.
The 5-year cardiac mortality rate has been reported to be more than 50% in patients with left main coronary artery (IMCA) stenosis. The puipose of this study was to visualize the LMCA using iutravascular ultrasound in patients who undergo interventions of the left anterior descending coronary artery (LAD) . This was done in order to see the incidence and severity of plaque formation in the LMCA in patients with severe LAD stenosis, and to address if scanning 1JV1CA is able to rule out LAD significant stenosis or vice versa. Methods A total of 293 patients with intervention of the LAD stenosis were examined with intravascular ultrasound( IVUS). The images of 278 patients were suitable for analysis. Results Fifty-three (19%) were found to have angiographic lumen reduction in the IMCA ranging from 11% to 35% (19±8%). Sixty-one patients were found to have native calcification in the LMCA. Atherosclerotic plaques in IMCA were detected in 211/278 (76%) patients, of which 164/211 (78%) were eccentric, and 51/211 (24%) had calcium deposit. The cross-sectional plaque area ranged from 1.5 mm" to 21 mm" (8.4 ±4.7 nim") . Area of stenosis was 34 ± 14% (8-66%) and diameter of stenosis was 21 ± 8% ( 7-42% ). A weak relationship concerning severity of stenosis between LAD stenosis and IMCA stenosis was found in the 59 patients with pre-interventional IVUS examinations ( r= 0.47, P < 0.05 ). Conclusions IMCA is frequently involved with atherosclerotic lesions in patients with severe LAD stenosis. A weak relationship does exist concerning the severity of stenosis between J^AD and IMCA. However, IVUS for LMCA lesion is not able to rule out I,AD stenosis.
Although congenital heart diseases are uncommon in the elderly, coronary artery anomalies may be incidentally discovered in old age. We sought to determine the incidence and clinical features of coronary artery anomalies (CAAs) in patients over 65 years of age. Patients and methods Medical records of patients undergoing coronary artery angiography in the years 1997-2002 at the Legnago General Hospital were retrospectively reviewed. The clinical profiles of all patients with CAAs and CAA subtypes were noted. Comparison between patients under and over 65 was performed. Data are given as mean standard deviation and as percentages. Results Sixty-six patients (1.21% , Female/Male 22/44, mean age 65.3 ± 10.6 years) out of the 5450 who underwent coronary angiography in the years 1997-2002 had CAAs. In most cases (63% , 41/66 patients), the patients were over 65. CAAs were discovered incidentally in these elderly patients while undergoing coronary artery angiography for dilated cardiomyopathy, ischemic heart disease, and valvular heart disease in 75% of the cases (30/41 patients). Patients over 65 had more cardiac comorbidities and a higher incidence of coronary atherosclerosis. Conclusions The angiographic incidence of CAAs in elderly patients is increasing as the population ages and this occurrence calls for a wider knowledge of the anatomy and pathophysiology of CAAs among geriatric cardiologists. Elderly patients seem to present with lower risk coronary anomalies (separated origin of left anterior descending coronary artery and circumflex artery, origin of circumflex artery from the right sinus or the right coronary artery, double coronary artery) but have a higher risk profile compared to younger patients due to the frequency of cardiac comorbidities and superimposed coronary artery atherosclerosis.
C-reactive protein (CRP) is associated with unfavorable outcome in patients with acute ischemic syndromes and in patients with chronic stable angina. Elevated CRP levels suggestive of heightened inflammatory state in vascular conditions are often associated with elevated interleukin-6 (IL-6) levels. The aim of our study was to show the predictive importance of CRP and IL-6 levels in patients with ischemic stroke that has not been fully elucidated. Design We studied 647 consecutive elderly patients ( > 65 years) with stroke who were documented with ischemic stroke, presence of significant carotid atherosclerosis and absence of atrial fibrillation. The study population included 150 patients (74 men, 76 women, mean age 74 ± 2) . Patients underwent evaluation of high sensitive CRP and II.-6 levels at baseline, during hospitalization and at discharge. Results In-hospital mortality was 6% , 1 year mortality was 15% and a second cerebrovascular event occurred in 12% of patients. Those with in-hospital events had significantly higher baseline CRP and IL-6 levels than patients without events (3.8 ± 1.1 vs 1.9 + 0.9 mg/L, P<0.01 and 13. 8 ±3.4 vs 6. 3 ±2.1 pg/ml, P<0.01, respectively). Also CRP and IL-6 levels were significantly higher in those patients with an event within 3 months of discharge compared to patients without an event (3.6 ± 1.3 vs 1.1 ± 0.7 mg/L, P <0.01 and 14.2 ± 3.7 vs 5.4 + 1.6 pg/ml, P<0.01, respectively). Both base line CRP levels and IL-6 were predictive of events both in-hospital and after 3 months while CRP and IL-6 levels at baseline were not associated with a poor 1 year prognosis. Elevated CRP levels were associated with an unfavorable outcome only when IL-6 levels were also elevated. In a stepwise multivariate analysis IL-6 level was a stronger predictor of outcome than CRP. Conclusions In conclusion, elevated CRP and IL-6 levels may identify elderly patients at increased medium term risk, but do not predict one year events in this subset of patients. CRP levels predict events only when they are coupled with IL-6 levels.
Osteoprotegerin (OPG) is a secreted protein of the tumor necrosis factor receptor family, which regulates bone mass by inhibiting osteoclast differentiation and activation. Although OPG is expressed ubiquitously and abundantly in many tissues and cell types including vascular cells, the role of OPG in other tissues is unknown. Our previous studies demonstrated that OPG was highly expressed in vascular smooth muscle cells (VSMC) and upregulated during vascular lesion formation. Methods and Results We documented, by Northern blot analysis, that the expression of OPG was more prevalent in the aorta and cultured VSMC from spontaneously hypertensive rats (SHR) compared to Wistar-Kyoto rats (WKY) . In addition, we found that the expression of Angiotensin II (Ang II) type I receptor (AT1R) in SHR VSMC was at significantly increased levels than in WKY VSMC. Furthermore, Ang
Multiple organ dysfunction syndrome in the elderly (MODSE) is an important syndrome in the critical care of elderly patients. MODSE is defined as simultaneous or sequential dysfunction or failure of two or more organs on the top of advanced age and chronic multiple organ dysfunction. MODSE is triggered by precipitating factors such as infection (usually pulmonary infection) trauma, surgery, etc. It occurs in two phases. In the early phase, dysfunction of multiple organs ( MODE) occurs, and in the later or severe phase, multiple organ failure (MOFE) occurs. MODSE is the most common cause of mortality in the critically ill elderly patient. It is important to understand its clinical characteristics and elucidate its pathogenesis in order to reduce mortality and improve Quality of life for these patients.
To establish a model of multiple organ dysfunction syndrome in the elderly ( MODSE) by intraperitoneal injection of different doses of zymosan, and to compare the multiple organ dysfunction syndrome (MODS) in adult and in the elderly rats. Methods Adult and senile rats, injected with different doses of zymosan intraperitoneally were examined for the changes in the function and morphology of the vital organs, including heart, liver, brain, lungs, and kidneys using blood gas and biochemistry analysis and histopathological examination methods.Results Compared with the normal controls of the adult and the elderly rats, the blood gas and blood biochemistry changed in different degrees in the different dosed zymosan groups. Pathological changes were also found in the vital organs including lungs, heart, liver, brain, kidneys, etc in the experimental groups. Under the same concentrations of zymosan, the reductions in respiratory, cardiac and renal functions in the senile groups were much more severe than those in the corresponding adult group. In the similar degree of model duplication, the senile rats had the tendency to die later than the adult rats. Conclusions Zymosan can be used in both elderly and adult rats to induce MODS model, and the best dosage for MODSE was 0.5g/kg injected peritoneally. The model would hopefully be used in the study of mechanisms and the therapeutics on MODSE.