Chronic Ischemic Heart Research Articles

Impairment of Left Ventricular Diastolic Function in Patients with Chronic Kidney Disease and Ischemic Heart Disease -Assessment by Myocardial SPECT

Impairment of Left Ventricular Diastolic Function in Patients with Chronic Kidney Disease and Ischemic Heart Disease -Assessment by Myocardial SPECT

Pilot Evaluation of a Novel Intra-Atrial Valved-Shunt (V-Wave Device) for Pressure-Dependent Cardiac Unloading in a Chronic Model of Ischemic Heart Failure

Increased left-ventricular (LV) diastolic pressures, occurring during heart failure (HF), can increase myocardial energy demand and facilitate maladaptive remodeling. We hypothesized that LV unloading during periods of volume overload can mitigate remodeling/functional deterioration in HF. Therefore, we studied a novel intra-atrial one-way (left-to-right) valve (V-Wave) designed to act as a selective/pressure dependent shunt, implanted in animals with chronic ischemic heart (HF).

Poor awareness of chronic kidney disease in patients with acute coronary syndrome--challenge for cardiologists and nephrologists

Sir, In the last issue of Nephrology, Dialysis and Transplantation, we read with great interest a review by Charles A. Herzog regarding kidney disease in cardiology [1]. In this article, the author highlighted three clinically relevant topics concerning acute kidney injury in patients with ischaemic heart disease, use of statins in chronic kidney disease (CKD) and ischaemic heart disease in patients with end-stage renal disease. In our opinion, this review omitted an important area, namely the poor awareness of CKD in patients with acute coronary syndrome (ACS) and cardiologists taking care of them. However, this very important topic is not often present in the literature. Epidemiologicalstudiesofrecentyearsfocusedontheincreased cardiovascular morbidity and mortality in patients with chronic kidney disease [2]. It was found that CKD is not only an important cause of arterial hypertension, left ventricle hyperthrophy and anaemia but also a risk factor for the development of accelerated arteriosclerosis and atheromatosis of both coronary and peripheral arteries (cardio-renal syndrome) [3]. Reddan et al. documented that almost 40% of patients with ACS suffer from at least stage 3 of CKD [4]. Therefore, we have performed a study that aimed to evaluate the awareness of CKD and effectiveness of the referral process to nephrologists in patients with ACS. The survey involved 150 patients (78 women and 72 men) with ACS referred to the cardiology unit [Table 1]. Patients were treated noninvasively or underwent urgent primary coronary intervention when TIMI Risk Score was equal or over 5 points. For each patient, detailed anamnesis concerning cardiovascular and kidney diseases and nephrological care was obtained. Based on estimated eGFR (MDRD formula) and urine analysis, CKD was diagnosed in 137 (91.3%) patients with ACS. eGFR <60 ml/min/ 1.73 m 2 was found in 29.3%, while proteinuria over 1 g/l in 9.3% of all patients with ACS. None of those patients was treatedbyanephrologistbeforetheoccurrenceofACS.The most frequently previously undiagnosed CKD was diabetic nephropathy (53%). After discharge from the cardiology unit, patients with diagnosed stages 3 and 4 of CKD or proteinuria over 1 g/l were referred to nephrologists. One-third of patients (n = 16) refused immediately. Finally, documented nephrological care during the 1-year follow-up period was undertaken only in 16 out of 48 initially referred patients (33.3%) (excluding 4 patients who died). Our results clearly indicate the poor awareness of CKD in patients with ACS. What is especially sad, is that even

Association between periodontal disease and ischemic heart disease among Swedish women. A cross-sectional study

Objective. The aim of this cross-sectional study was to analyze the relationship between chronic periodontitis and ischemic heart disease (IHD). Material and Methods. A cross-section of women aged 38 to 84 years were examined in 1992–93 (analysis based on n=1056). Medical and dental examinations were included in the analysis specifically with regard to IHD and periodontitis. Other well-known risk factors for IHD were used as covariates in multivariable statistical analysis. Results. Among the dentate women in this study (n=847), 74 had IHD and 773 did not. There was no statistically significant difference between numbers of pathological gingival pockets between these groups (58.1% had one or more pathological pockets in the IHD group compared to 57.6% in the non-IHD group). Bivariate analysis of dentate individuals showed significant associations between IHD and number of missing teeth, age, body mass index, waist/hip ratio, life satisfaction, hypertension, and levels of cholesterol and triglycerides. However, in the final multivariable logistic regression model, with the exception of age, only number of teeth (<17 teeth) OR = 2.13 (CI 1.20; 3.77) was found to be significantly associated with IHD. Moreover, edentulous women had an OR of 1.94 (CI 1.05; 3.60) in relation to IHD (age-adjusted model). Conclusions. In the present study, periodontitis did not seem to have a statistically significant relationship with IHD. The number of missing teeth showed a strong association with IHD, and this may act as a proxy variable tapping an array of different risk factors and behaviors.

CHANGES OF INTERCELLULAR COOPERATION IN PERIPHERAL BLOOD IN TREATED PATIENTS WITH CARDIOLOGIC DISEASES

Aim. To study changes of intercellular cooperation in peripheral blood induced by treatment in patients with arterial hypertension (HT), ischemic heart disease (IHD) and chronic heart failure (CHF). Material and methods. 610 patients were involved into the study, including 250 patients with HT of stages I-III (50 untreated patients), 150 patients with IHD and 210 patients with CHF of stages I-III. All patients were treated except 50 hypertensive ones. 80 healthy patients (40 men, 40 women) were included into control group. Blood smears of patients were evaluated (Romanovsky's stain). A number of leukocyte, autorosettes and autorosettes with erythrocyte lysis was calculated. The cellular association consisting of a neutrophil, monocyte or eosinocyte with 3 or more erythrocytes skintight to their surface defined as autorosettes. Erythrocytes number and hemoglobin level determined in peripheral blood. Results. Single autorosettes in peripheral blood were observed in patients of control group and in untreated patients with HT. Treated patients with HT, IHD and CHF had increased number of autorossets and autorosettes with erythrocytes lysis. This phenomenon resulted in reduction of erythrocytes number and hemoglobin level in peripheral blood. Conclusion. Treated patients with cardiologic diseases had changes in intercellular cooperation. It should be considered at intensive and long term therapy.

Management of Ischemic Heart Disease in Patients with Chronic Kidney Disease

Patients with chronic kidney disease (CKD) and ischemic heart disease (IHD) have strikingly high mortality rates. In the general population, there has been a reduction in the mortality and morbidity rates for IHD through the implementation of effective risk-factor-reduction programs and better interventions for patients with established IHD. No such trend has been observed in patients with end-stage kidney disease. This review article addresses the following topics: (i) epidemiology, pathogenesis, clinical CKD patients with IHD; (ii) diagnostic modalities for IHD and their limitation in CKD patients; (iii) medical treatment options and revascularization strategies for these high-risk patients; and (iv) optimal cardiovascular risk management. Generally, in CKD patients with IHD an aggressive approach to IHD is warranted, a low threshold for diagnostic testing should be employed, and awaiting a clinical trial targeting these patients they should be considered for all proven strategies to improve outcomes.

EFFECT OF AMLODIPINE AND OF NIFEDIPINE RETARD ON AUTONOMIC REGULATION OF HEART RATE IN ELDERLY PATIENTS WITH ARTERIAL HYPERTENSION

Aim. To study the effect of the monotherapy with calcium channel blockers (amlodipine, 5 mg/d and nifedipine retard, 40 mg/d) on heart rate variability (HRV) in elderly hypertensive patients with different rate of biological ageing. Material and methods . 55 male hypertensive patients of 60-86 years with ischemic heart disease and chronic heart failure, class I-III (NYHA), were examined. Biological age was determined by the linear regression. HRV was determined by cardiointervalography and variation pulsemetry at the rest and in orthostatic test. Patients were split in to 2 groups (I - normal; II - fast ageing rate) and treated with the investigated drugs for 4 weeks. At the baseline and at the end of the study HRV and clinical blood pressure (BP) were determined. Results. Normal sympathetic activity and moderate overactivity was observed in patients of I group, and prominent sympathetic overactivity - in patients of II group. Monotherapy with amlodipine in patients of I and II groups improved indices of HRV (variation range, dispersion and stress index) and provided target BP reduction. Monotherapy with nifedipine retard in patients of I group elevated variation range, decreased stress index and provided target BP reduction. Sympathetic activity was not changed in patients of the II group. Autonomic regulation was normalized due to amlodipine and nifedipine retard therapy in patients of the both groups. Conclusion. The sympathetic overactivity is observed in elderly hypertensive patients. Monotherapy with calcium blockers improves HRV and provides target BP reduction.

Smoking-related Emphysema and Interstitial Lung Diseases

Smoking-related illnesses contribute to a large number of deaths in the industrialized world and their treatment comprises a substantial percentage of total healthcare dollars. The most common and most well-known smoking-related illnesses include chronic obstructive pulmonary disease, bronchogenic carcinoma, and ischemic heart disease. However, the role of cigarette smoking in the pathogenesis of other lung diseases is becoming increasingly apparent. Knowledge of both the histologic and radiographic manifestations of smoking-related lung disease is important to the radiologist as imaging findings can be nonspecific. Finally, correlation of imaging and clinical information may obviate the need for open lung biopsy.

342 Emotional status at patient with ischemic heart disease and chronic heart failure and metabolic syndrome

342 Emotional status at patient with ischemic heart disease and chronic heart failure and metabolic syndrome

EFFECTS OF Β-ADRENOBLOCKERS ON MYOCARDIAL REMODELING, IMMUNO-INFLAMMATORY REACTIONS AND ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH ISCHEMIC HEART DISEASE AND CHRONIC HEART FAILURE

Aim. To assess the effect of β-adrenoblockers (BAB) on myocardial remodeling, immuno-inflammatory reactions and endothelial dysfunction in patients with ischemic heart disease and chronic heart failure (CHF). Material and methods. 84 patients with ischemic CHF of II-IV functional class were involved in the study. They were randomized in two groups. The first group was presented with 43 patients receiving carvedilol in addition to standard therapy for 24 weeks; the second group was presented with 41 patients receiving metoprolol. Echocardiography, 6-minute walk test were applied. Blood levels of primary and secondary lipid peroxidation (LP) products, cytokines, endothelin-1 (ET-1), intercellular adhesive molecule (VCAM-1) were determined. Results. Both of BAB improved the clinical condition and physical working ability of patients with CHF. Carvedilol in comparison with metoprolol was more effective in myocardial remodeling prevention, inhibition of pro-inflammatory cytokines [tumor necrosis factor alpha (TNF-α), interleukins (IL-1β IL-6)] and LP. Besides carvedilol increased in endothelium-dependent vasodilatation and reduced in ET-1 and VCAM-1 levels. Conclusion. Long-term carvedilol treatment has anti-inflammatory, antioxidant and endothelium-protective effects as well as improves haemodynamics.

130 Endothelium-dependent prothrombotic and fibrinolytic factors in patients with ischaemic heart disease and chronic heart failure

130 Endothelium-dependent prothrombotic and fibrinolytic factors in patients with ischaemic heart disease and chronic heart failure

Bone marrow cells for cardiac repair

Bone marrow cells for cardiac repair

Dynamic and not static change in ventricular repolarization is a substrate of ventricular arrhythmia on chronic ischemic myocardium.

The restitution mechanism has been the focus of attention as the possible mechanism behind ventricular fibrillation (VF). However, its contribution in chronic ischemic heart has not been established. We investigated chronic ischemic dogs with occlusion of left anterior descending artery. Sixty unipolar electrograms were simultaneously recorded from an entire cardiac surface. Activation-recovery intervals (ARIs) and QRST deflection area (AQRST) were measured during constant atrial pacing. The ischemic dogs were divided into two groups, five dogs in VF(+) group or seven dogs in VF(-) group, according to VF occurrence by programmed electrical stimulation. When investigating ARI dispersions on an epicardium, there was no difference between VF(+) and VF(-) groups. The relationship between ARIs and diastolic intervals was quantified as an electrical restitution curve. The slopes of the ARI restitution curve for the anterior left ventricle in VF(+) dogs were significantly steeper than those of VF(-) dogs. The amplitude of AQRST alternans were significantly greater in VF(+) dogs than VF(-) dogs. Combined observation of steep restitution slopes and increased electrical alternans supported the restitution mechanism as being involved in the arrhythmia. Dynamic restitution properties and not static single-beat ARI dispersion may play an important role in the VF arrhythmia in the chronic ischemic heart.

Relationship between the functional status of neutrophils and the intensity of peroxidation in the lungs in chronic bronchitis and ischemic heart disease

A relationship between the oxygen metabolism of circulating neutrophils and the intensity of lipid peroxidation in exhaled air condensate was studied in chronic bronchitis, ischemic heart disease, and in their combination. An increase in the functional reserve of neutrophils caused by ischemic heart disease promotes the realization of the bio-oxidant potential of these cells in the bronchoalveolar system and intensifies local processes of lipid peroxidation.

Effects of Diesel Equipment Usage on Prevalence of Chronic Bronchitis, Lung Carcinoma and Ischaemic Heart Disease in Coal Workers

Effects of Diesel Equipment Usage on Prevalence of Chronic Bronchitis, Lung Carcinoma and Ischaemic Heart Disease in Coal Workers

Mortality from asthma in Western Australia

From a cohort of all 5760 male and 4979 female patients who were admitted to WA hospitals and were discharged with a diagnosis of asthma between 1976 and 1980, 265 deaths in men and 189 deaths in women were identified by the end of 1982. The standardized mortality ratio (SMR) for all causes of death for this cohort was 1.6 for men (P less than 0.001) and 1.7 for women (P less than 0.001). Both sexes showed a significant increase in deaths that were attributable to asthma (SMR, 57.9), chronic airflow obstruction (SMR, 9.3) and ischaemic heart disease (SMR, 1.3). The excess death rates for asthma were observed in all age groups, but those for chronic airflow obstruction and ischaemic heart disease were present in older age groups only. These findings indicate that asthma remains a potentially fatal disease in the Australian community. The excess mortality ratios for chronic airflow obstruction that were observed in patients who were admitted to hospital with asthma also suggest that asthma may result in irreversible airflow obstruction.

Central Alpha-Adrenergic Agonists in Chronic Heart Failure and Ischemic Heart Disease

Central alpha-adrenoceptor agonists (methyldopa, clonidine, guanabenz) decrease sympathetic outflow and renin and vasopressin secretion as well as increase parasympathetic activity. These drugs are commonly employed as antihypertensives. Two other conditions, chronic heart failure and ischemic heart disease, may also benefit from central alpha-adrenergic stimulation. In both acute and chronic heart failure, central alpha-adrenoceptor agonists reduced cardiac work load by decreasing heart rate, systemic arterial pressure and reducing venous tone. Also, plasma catecholamines were decreased. Exercise at comparable work loads was achieved at a lower pressure-rate product and effort capacity was sometimes increased. Central alpha-adrenoceptor agonists increased effort capacity in patients with ischemic heart disease and angina pectoris. Again, the benefits are thought to be decreased heart rate, systemic arterial blood pressure and rate-pressure products during exercise; catecholamines are reduced in these patients as well. Central alpha-adrenoceptor agonists offer another avenue of approach to alter neurohumoral factors in congestive heart failure and ischemic heart disease and thereby produce beneficial hemodynamic response.

Pharmacokinetic and haemodynamic studies with prazosin in chronic heart failure.

Pharmacokinetic and haemodynamic studies with the alpha-1 adrenoceptor antagonist prazosin were made in 15 patients disabled by chronic severe ischaemic heart failure. In six patients given doubling doses of oral prazosin on successive days, the peak plasma concentration and area under the concentration-time curve were linearly related to the oral dose. The pharmacodynamic response was a dose-related fall in the systemic arterial pressure, both supine and standing; dose-response effects were most evident in the upright posture. Severe hypotension occurred unpredictably, and was unrelated to coexisting clinical or radiographic features. There was a reciprocal relationship between the reduction in systemic blood pressure and the increase in heart rate. In 9 patients, the acute haemodynamic effects of a single oral dose of 2 mg prazosin was examined in the upright posture at rest and during treadmill exercise. There was a reduction in the systemic and pulmonary vascular pressures and resistance without change in the cardiac output. These studies outline the specific pharmacokinetic alterations of the handling of prazosin in patients in heart failure and the associated haemodynamic activity of the drug.

Giving up smoking: how doctors can help

Cigarette smoking remains the most important preventable cause of premature death in the western world How best to help adults to give up cigarettes and stop the young from starting is unknown. If all doctors gave up cigarette smoking the example might be their most useful contribution to preventive health care. Health Education campaigns and anti-smoking clinics have had little success. Yet about one out of every four patients can stop after firm unequivocal advice from the doctor to do so.1Where motivation was increased by a recent myocardial infarction, 62% of patients were persuaded by their doctor to stop for at least one year.2No method is known to be more effective than this personal advice from doctor to patient, yet many patients have never been told by their doctor to stop smoking, even for chronic bronchitis or ischaemic heart disease.