Changes In Coronary Vessels Research Articles

Clinical characteristics of Kawasaki disease in Polish children: A retrospective study.

Kawasaki disease (KD), an acute, generalized vasculitis, is associated with an increased risk of coronary heart disease and is the most common cause of acquired heart disease in childhood. The incidence of KD is increasing worldwide. Our study aims to analyze KD's clinical course in children and to evaluate risk factors for persistent changes in coronary vessels after 6-8 weeks of treatment. The retrospective analysis included patients with KD hospitalized in a single tertiary carehospital. The diagnosis, as well as treatment, were based on the current worldwide treatment standards. The clinical course, selected laboratory parameters, the treatment effect, and following cardiac complications were analyzed in different age groups. In the years 2006-2019, 140 patients aged from two months to 16 years: 52 girls and 88 boys, were diagnosed with KD. Coronary artery aneurysms (CAA) at weeks 6-8 of disease were found in 16% of patients. Boys and infants were more likely to develop aneurysms at weeks 6-8 of the disease (P = 0.045; P = 0.03; respectively). The CAA frequency was related to the atypical course (P = 0.02), late diagnosis (P = 0.04), presence of changes in the coronary arteries at the time of diag nosis (P<0.001), immunoglobulin resistance (P = 0.002), a lower hemoglobin concentraction (P<0.001), and a higher platelet count (P = 0.02). There were 28% of patients resistant to first-line time treatment. In this group, we found CAA in 31% of children. We found that late diagnosis, low hemoglobin level, high platelet count, CAA presence at diagnosis, atypical course of KD, and resistance to intravenous immunoglobulins are predictors of CAA after 6-8 weeks in KD patients.

General practitioner’s tactics in the management of patients with stable angina

Ischemic heart disease (IHD) is one of the most common diseases of the cardiovascular system, which is based on a disorder of the trophism of the heart muscle against the background of pathological changes in the coronary vessels. The leading factor in changes in coronary vessels is stenosing atherosclerosis, which results in impaired blood flow. Risk factors include male gender, older age, a burdened familial history, as well as low physical activity, arterial hypertension, diabetes mellitus, and obesity. Ischemic heart disease is the leading cause of death, especially in developed countries, and the number one cause of medical visits related to heart and vascular problems. One of the most common manifestations of ischemic heart disease is angina pectoris. When pain sensations appear against the background of physical activity or emotional stress, it is called angina of effort, but if angina manifestations occur outside the period of physical and mental activity, we are speaking about resting angina pectoris. There are acute and chronic forms of ischemic heart disease, and while cardiologists and cardiac resuscitators usually deal with acute conditions, dynamic monitoring of patients after a myocardial infarction or with angina pectoris is a part of the responsibility of a general practitioner.

Ischemic heart disease (IHD) is one of the most common diseases of the cardiovascular system, which is based on a disorder of the trophism of the heart muscle against the background of pathological changes in the coronary vessels. The leading factor in changes in coronary vessels is stenosing atherosclerosis, which results in impaired blood flow. Risk factors include male gender,

In their practice, family doctors may encounter symptoms that require differential diagnosis between organic and functional disorders of the gastrointestinal tract and malignant neoplasms. The similarity of the clinical picture in some cases requires timely making the right decision about the tactics of examination, additional diagnostic measures and further referral to specialized medical institutions for treatment. One of these diseases that do not have specific clinical features at an early stage is gastric cancer, which is a malignant degeneration of the epithelium of the gastric mucosa. Symptoms of gastric cancer in its initial stages are limited to dyspeptic disorders, loss of appetite and unexpressed asthenia, which makes its manifestations similar to many diseases that affect the gastrointestinal tract — gastritis, peptic ulcer of the stomach and duodenum, adenomatous polyps of the gastric mucosa. The main diagnostic method that allows making the correct diagnosis is gastroscopy, which makes it possible not only to assess the condition of the mucosa, but also to take material for a biopsy with further histological examination of the tissue. Since the main treatment for gastric cancer is surgery, a correct and timely diagnosis plays a significant role in the further prognosis of the disease and the patient's quality of life.

Structural and Functional Changes in Coronary Vessels in Patients with Coronary Heart Disease in Combination with Type 2 Diabetes

Cardiovascular complications are a major cause of morbidity and mortality in diabetes mellitus (diabetes mellitus) (80% of patients with type 2 diabetes mellitus die from cardiovascular complications). Coronary heart disease (CHD) in patients with type 2 diabetes manifests 2-3 times more often than in people of the same age without diabetes. The heart is one of the main target organs in diabetes, and its functional state largely determines the course and prognosis of cardiovascular complications in patients with diabetes.The objective: to evaluate the features of coronary artery disease in patients with coronary heart disease, depending on the presence of type 2 diabetes.Materials and methods. 100 patients with coronary heart disease were examined: stable angina pectoris, among which 60 patients with CHD were combined with type 2 diabetes and 40 patients with coronary heart disease: stable angina pectoris II–III FK with no carbohydrate metabolism disorders. Non-invasive CT angiography was performed to assess the status and coronary artery patency of the coronary arteries. With the help of MSCT it is possible to obtain unique information on the presence of coronary artery calcinosis, the so-called total calcium index (SCI) – calcinosis of coronary arteries, reflecting its degree.Results. In the course of MSCT, the presence of coronary artery calcinosis was found – the total calcium index. The data obtained in the study show the adverse effect of the violation of carbohydrate metabolism on the development and progression of the atherosclerotic process. For patients with type 2 diabetes mellitus is characterized by a multicentric, diffuse defeat of the coronary bed. Among patients in group 1, three-vessel lesions of the CA were significantly more common, while in patients of the 2nd group, one and two-vessel atherosclerotic lesions of the CA were significantly more likely to be registered. Patients with coronary heart disease and concomitant type 2 diabetes had more severe coronary artery disease than those without concomitant DMD type 2. For patients with coronary heart disease and concomitant diabetes mellitus type 2, early calcinosis of the large cardiac vessels is characteristic according to the MSCT. A high correlation between the total calcium index and carbohydrate metabolism indices (HvA1c,%), lipid metabolism (LPDH, TG, IA) was found in patients with coronary artery disease with concomitant DM type 2, indicating the effect of carbohydrate and lipid metabolism disruption on the process of atherogenesis, which is more pronounced in patients with type 2 diabetes.Conclusions. The SCI score obtained by the MSCT indicates the prescription of atherosclerotic lesions and allows to assess the risk of destabilization of atherosclerosis and the development of cardiovascular catastrophes. MSCT-coronography opens new possibilities for the diagnosis of coronary artery disease with the detection of atherosclerotic changes in the vessels of the coronary bed, the establishment of localization and the degree of stenosis in the coronary arteries.

Highlights From the Circulation Family of Journals.

Highlights From the Circulation Family of Journals.

Dietary Patterns Seem to Influence the Development of Perfusion Changes in Cardiac Syndrome X Patients.

Cardiac syndrome X(CSX) is linked with changes in the heart'smicro-vasculature, without significant changes in main coronary vessels. According to ESC 2013 stable coronary artery disease criteria, CSX was replaced by Microvascular Angina (MA). While no changes in main coronary vessels are present, most patients still suffer from angina-like chest pains, which significantly diminish their quality of life. CSX is recognized among other coronary diseases and is now considered to be aform of stable angina. In most CSX patients we can visualize perfusion changes in the left ventricle. Since it is well known that the kind of diet can greatly influence the development of coronary disease, our aim was to evaluate the influence of diet on the myocardial perfusion in the group of patients who were diagnosed of CSX. In addition, we tried to verify whether there is any correlation between dietary patterns and perfusion changes visualized in this group of patients. Toward this goal we screened for the presence of CSX agroup of 436 women who suffered from angina-like symptoms and whose routinely performed angiography revealed no changes in coronary vessels. Out of these, 55 women with CSX diagnosis, completed questionnaires regarding their nutritional patterns and underwent both myocardial perfusion studies (MPI) and exercise tests. In the studied group dietary patterns were far from normal values, with the majority of women consuming too much protein, animal fats and sugars in their daily diet, and too low amounts of complex carbohydrates and oils. We were not able to find definite correlations between diet and perfusion changes; however, women whose diet included too high fat and protein intake, seemed to have worse perfusion pattern in MPI. Nutritional pattern seems to have an impact on development of myocardial perfusion changes in CSX patients.

Exercise increases serum endostatin levels in female and male patients with diabetes and controls

BackgroundType 2 diabetes mellitus (T2DM) is often associated with atherosclerotic changes in coronary vessels, most notably plaques. The angiostatic parameter endostatin is able to inhibit angiogenesis in tissue as well as in plaques and therefore plays an important role in physiological and pathological neovascularisation. The aim of the present study was to investigate sex-specific differences and the influence of exercise on circulating endostatin levels in patients suffering from diabetes, and control subjects.MethodsIn total, 42 T2DM-patients and 45 control subjects were investigated. They underwent a graded physical stress test (ergometry). Serum endostatin levels were measured in venous blood at rest and directly after reaching maximum workload.ResultsFemales showed significantly higher endostatin levels at baseline measurements compared to men, independently of their underlying disease. In both female and male T2DM-patients endostatin levels were significantly lower compared to controls. Both groups and sexes showed a significant increase of endostatin after physical stress, whereas the extent of endostatin-increase was between 10.59-15.05%.ConclusionMiddle-aged healthy female individuals as well as female T2DM-patients showed higher circulating serum endostatin levels compared to males, suggesting a hormonal influence on baseline circulating endostatin amounts. Exercise-induced increase in endostatin is also observable in patients suffering from T2DM. Concerning vascularisation, lower endostatin levels in T2DM might be advantageous. Concerning plaque stability, lower levels might be prejudicial.Trial registrationClinical Trial Registration-URL: http://clinicaltrials.gov/ct2/results?term=NCT01165515

2-Methoxyestradiol attenuates hypertension and coronary vascular remodeling in spontaneously hypertensive rats

ObjectivesAccumulating data provide evidence that some metabolites of 17β-estradiol are biologically active and mediate multiple effects on the cardiovascular and renal systems. We investigated the effect of 2-methoxyestradiol (an active metabolite of estradiol with non-feminizing activity) on the development of hypertension and myocardial vascular remodeling in male and female ovarectomized SHR. MethodsRats were divided into five groups: intact females, ovarectomized (OVX), OVX+ 2-methoxyestradiol (2ME), control males, and male+2ME. Systolic blood pressure was determined from 10 to 18 weeks. Structural changes in coronary vessels were quantified by an image analyzer. Immunoblotting of phosphorylated ERK1/2 and NADPH oxidase activity were performed on mesenteric arteries. ResultsTreatment with 2ME reduced the increase in systolic blood pressure in male and ovarectomized rats to values not different from those obtained in intact females. Myocardial arterioles and small arteries showed significant increases in wall-to-lumen ratio and perivascular fibrosis in male and ovarectomized rats when compared with intact females. NADPH oxidase activity was increased in mesenteric arteries from males and ovarectomized females as compared with intact females. Finally, the expression of phosphorilated ERK1/2 were significantly higher in mesenteric arteries from male and ovariectomized animals than in those from intact females. Those effects of ovarectomy and gender differences were totally or partially prevented by treatment with 2-methoxyestradiol. ConclusionsThese data demonstrate that 2-methoxyestradiol protects the vasculature from hypertension-induced myocardial arterial remodeling in male and ovarectomized SHR, and that might be in part related to decreased superoxide generation and ERK1/2 activation.

Correlation of epicardial and systemic flow-mediated vasodilation in patients with atypical angina but no evidence of atherosclerotic disease

Atypical angina represents a diagnostic challenge and can be observed in the absence of significant coronary atherosclerosis. Endothelial dysfunction is a relevant marker of prognosis, considering cardiovascular events. The aim of the present study was to compare flow-mediated vasodilation (FMD) in systemic peripheral and epicardial coronary arteries. If noninvasive measurements of FMD in systemic arteries correlated with invasive measurements of coronary FMD, this may facilitate diagnostic approaches and determination of prognosis in patients with atypical angina in the future. Patients with atherosclerosis were excluded, because structural changes of coronary vessels may impair adequate comparison. Endothelial function (ENF) of epicardial and systemic arteries was examined in 61 consecutive patients with atypical angina in whom significant atherosclerosis was excluded by coronary angiography. ENF of the epicardial arteries was examined during heart catheterization, measuring diameter changes of the proximal left anterior descending coronary artery (LAD) in response to reactive hyperemia, induced by locally administered adenosine via infusion catheter to the mid-segment of the LAD (coronary FMD [FMDc]). ENF of the radial artery was examined with high-resolution ultrasound, measuring peripheral FMD (FMDp) in response to reactive hyperemia induced by distal cuff occlusion. Endothelium-independent vasoreactivity to glycerol trinitrate was assessed. In patients with atypical angina in the absence of atherosclerosis, there was a significant correlation in ENF between coronary and systemic arteries (r=0.437; P=0.001). The underlying disease was myocardial inflammation (Inf) in 48 patients, in whom the mean (+/- SD) ENF of epicardial (FMDc-Inf 3.40+/-5.55%) and systemic (FMDp-Inf 3.69+/-2.93%) arteries was significantly impaired (P<0.001), compared with 13 control (Co) patients who had normal myocardial biopsies (FMDc-Co 14.51+/-8.62%; FMDp-Co 7.69+/-3.42%). FMD of coronary (r=-0.353; P=0.005) and systemic (r=-0.542; P<0.001) arteries correlated significantly with myocardial inflammation and endothelial activation. There was a significant correlation in FMD between coronary and systemic arteries in patients with atypical angina but without significant atherosclerosis. Inflammatory processes are associated with endothelial dysfunction of both vascular regions.

Effect of estrogen and angiotensin-converting enzyme inhibitor on vascular remodeling in ovariectomized spontaneously hypertensive rats

The present study evaluated whether estrogen influences the effect of angiotensin-converting enzyme inhibition in preventing the vascular remodeling induced by hypertension and also investigated the signal mechanism involved in that effect. Ten-week-old female spontaneously hypertensive rats were ovariectomized (OVX) and randomly assigned to the groups: untreated OVX and treated with 17beta-estradiol (estradiol, 1.5 mg) and/or captopril (5 mg/kg/day). Evolution of systolic blood pressure was determined until 18 weeks. At that time, the heart and mesentery were excised. Structural changes in coronary vessels were quantified by an image analyzer. Inmunoblotting was performed on mesenteric arteries for determination of phosphorylated (ERK1/2). Estradiol treatment enhanced the antihypertensive effect of captopril in OVX rats. Treatment with captopril slightly modified the media cross-sectional area and wall-to-lumen of myocardial arterioles from OVX spontaneously hypertensive rats, whereas coadministration of captopril and estradiol significantly reduced the media cross-sectional area, wall-to-lumen ratio, and perivascular fibrosis in OVX spontaneously hypertensive rats. Captopril alone did not significantly inhibit extracellular signal-regulated kinase 1/2 phosphorylation, whereas coadministration of captopril and estradiol significantly attenuated this parameter. These results indicate that estrogen may enhance the angiotensin-converting enzyme inhibition-mediated improvement of vascular remodeling in hypertension, which may be partly mediated via inhibition of extracellular signal-regulated kinase 1/2.