Complications Of Ischemic Heart Disease Research Articles

Thromboxane A2: Mechanisms of Synthesis and Intracellular Signaling System of Realization

One of major complications of ischemic heart disease is myocardial infarction, which develops as a result of thrombosis at the site of ruptured atherosclerotic plaque. Platelets activation and aggregation are the key events of this process. The efficiency of aspirin and/or clopidogrel use is limited by residual platelet reactivity what indicates the need to explore its mechanisms. This review covers intracellular signaling systems involved in realization of effects of the main platelet agonists in order to specify new molecules for the target therapy in case of aspirin resistance.

The influence of concomitant diseases on a long-term prognosis in patients with chronic ischemic heart disease according to the PROGNOZ IBS register

Aim. To study the incidence of comorbidities and their impact on the prognosis in patients with ischemic heart disease (IHD) included into the PROGNOZ IBS Register. Material and methods. Data from the PROGNOZ IBS register of patients diagnosed with IHD using coronary angiography during the reference hospitalization (n=541; 432 male and 109 female) was included in the analysis. 504 (93%) patients were included in the survival analysis. Risk factors of cardiovascular diseases, associated with atherosclerosis, or those that were complications of IHD were considered as comorbidities as well as not cardiovascular diseases – chronic obstructive pulmonary disease, bronchial asthma and chronic kidney disease (CKD). Results. The average duration of follow-up was 7.3±2.19 years. The average number of comorbidities in patients with IHD was 1.83. Comorbidities worsened the prognosis of life: the presence of diabetes mellitus (DM) increased the relative risk (RR) of primary endpoint occurrence by 1.7 times, the combination of DM with hypertension – by 2.4 times, a history of stroke – by 2.3 times (p<0.05); 2 and 3 heart diseases – respectively, by 2.3 and 3.2 times (p<0.05); a combination of chronic lung diseases and CKD stages 3-5 – by 1.4 times (p=0.06); the presence of 2, 3, 4 and 5 comorbidities – respectively, by 4, 5, 6.4 and 13 times (p<0.001). The risk of death from all causes was determined by the number of concomitant cardiovascular diseases: 2 diseases increased RR by 2.3 times, 3 diseases – by 4.6 times, a combination of any 4 diseases – by 3.5 times, of 5 diseases – by 5 times (p<0.05). Conclusion. Prognosis of life in IHD patients is worsened by the presence of several comorbidities: risk factors of cardiovascular disease (DM and hypertension), cardiovascular diseases associated with atherosclerosis or those that are complications of IHD, chronic lung diseases and CKD.

Potential Biomarkers of Insulin Resistance and Atherosclerosis in Type 2 Diabetes Mellitus Patients with Coronary Artery Disease

Type 2 diabetes mellitus patients with coronary artery disease have become a major public health concern. The occurrence of insulin resistance accompanied with endothelial dysfunction worsens the state of atherosclerosis in type 2 diabetes mellitus patients. The combination of insulin resistance and endothelial dysfunction leads to coronary artery disease and ischemic heart disease complications. A recognized biological marker, high-sensitivity C-reactive protein, has been used widely to assess the progression of atherosclerosis and inflammation. Along with coronary arterial damage and inflammatory processes, high-sensitivity C-reactive protein is considered as an essential atherosclerosis marker in patients with cardiovascular disease, but not as an insulin resistance marker in type 2 diabetes mellitus patients. A new biological marker that can act as a reliable indicator of both the exact state of insulin resistance and atherosclerosis is required to facilitate optimal health management of diabetic patients. Malfunctioning of insulin mechanism and endothelial dysfunction leads to innate immune activation and released several biological markers into circulation. This review examines potential biological markers, YKL-40, alpha-hydroxybutyrate, soluble CD36, leptin, resistin, interleukin-18, retinol binding protein-4, and chemerin, as they may play significant roles in insulin resistance and atherosclerosis in type 2 diabetes mellitus patients with coronary artery disease.

Hypoxia-inducible plasmid expressing both miSHP-1 and HO-1 for the treatment of ischemic disease

Ischemic heart disease (IHD) is one of the leading causes of death worldwide. Unfortunately, current pharmacological treatments for ischemic heart disease do not reliably prevent the remodeling of the left ventricle and the progression to heart failure. Gene therapy offers a novel means to directly treat the pathophysiology underlying the long-term complications of ischemic heart disease. To date, gene therapies directed at single molecular targets have not been successful in the treatment of ischemic heart disease. In this study, we describe a gene therapy combination for inhibiting cardiomyocyte apoptosis under hypoxic conditions. This gene therapy combination utilizes a hypoxia-inducible plasmid expressing both heme oxygenase-1 (HO-1) and the Src homology domain-2 containing tyrosine phosphatase-1 microRNA (miSHP-1): pEpo-SV-miSHP-HO-1. This novel gene therapy construct demonstrated an enhanced expression of HO-1, production of miSHP-1, down-regulation of SHP-1, and inhibition of cardiomyocyte apoptosis under hypoxic compared to normoxic conditions. These results suggest that pEpo-SV-miSHP-HO-1 may be a promising gene therapy combination construct for the clinical treatment of ischemic disease.

虚血性心疾患の合併症に対する外科治療 Surgical Treatment for Complications of Ischemic Heart Disease

虚血性心疾患の合併症に対する外科治療 Surgical Treatment for Complications of Ischemic Heart Disease

Outcomes of Mitral Valve Repair for Chronic Ischemic Mitral Regurgitation

Mitral regurgitation is a frequent complication of ischemic heart disease. A retrospective study was performed on 127 patients with significant ischemic mitral regurgitation (regurgitant jet area > or =6.0 cm2 and/or vena contracta width > or =0.70 cm) who underwent elective mitral valve repair between January 2001 and October 2007. Concomitant myocardial revascularization was carried out in all except one patient, and left ventricular restoration in 8. All patients had ring annuloplasty, with release of posterior mitral leaflet tethering in 21, leaflet resection in 7, chordal transfer in 3, and chordal shortening in 2. There were 4 (3.1%) hospital deaths. Two patients underwent successful mitral valve replacement for repair failure in the immediate postoperative period, and one had an unsuccessful valve replacement at 3 months. During a mean follow-up of 19.65 +/- 13.21 months in 121 patients, 111 had trivial or no residual regurgitation, and 10 had mild regurgitation. Mitral valve repair for chronic ischemic mitral regurgitation is a reproducible technique with satisfactory early and mid-term outcomes and freedom from valve-related complications.

Diesel Fumes Do Kill: A Case of Fatal Carbon Monoxide Poisoning Directly Attributed to Diesel Fuel Exhaust with a 10‐year Retrospective Case and Literature Review*

While it is known that diesel fuel combustion engines produce much lower concentrations of carbon monoxide (CO) than gasoline engines, these emissions could certainly generate lethal ambient concentrations given a sufficient amount of time in an enclosed space and under suitable environmental conditions. The authors report a case of CO poisoning which was initially referred for autopsy as a presumed natural death of a truck driver found in the secure cab of a running diesel tractor trailer truck. Completion of the preliminary investigation ascribed death to complications of ischemic heart disease (IHD), pending toxicological analysis that included quantification of CO. When the toxicology results showed lethal blood COHbg, the cause of death was re-certified as CO intoxication secondary to inhalation of (diesel) vehicular exhaust fumes. Because of the unique source of fatal CO intoxication in this case, the contributory IHD and the possible contaminants in the putrefied blood, a 10-year retrospective review was conducted on all nonfire related CO deaths autopsied (n = 94) at the Office of the Chief Medical Examiner in Louisville, KY from 1994 to 2003. For validation of the COHbg detection method used by the Kentucky Office of Forensic Toxicology (KYOFT), blood samples from these cases along with controls were submitted to three laboratories using various analytical methods yielding no statistically significant differences. Lastly, an extensive literature review produced no scientifically reported cases of fatal CO poisoning attributed to diesel fuel exhaust.

Insuffisance mitrale ischémique

Summary Ischemic mitral regurgitation Mitral regurgitation (MR) is a serious complication of coronary heart disease. The functional form is the most frequent, often presenting with a dynamic character. The presence, and in particular the severity of MR and its dynamic character have a major impact on the medium and long term prognosis. The mechanisms responsible for MR are complex and occur in a state of disequilibrium between traction forces and closing forces, for which the significance is partly affected by the presence of asynchrony in left ventricular contraction. The therapeutic management of these patients is difficult. In cases of proven asynchrony, implantation of a biventricular pacemaker is justified. A mitral surgical procedure may be envisaged in cases of severe MR where bypass surgery is planned. In cases of moderate MR at rest, an evaluation of its dynamic character on effort can assist with the decision to undertake combined surgery. Mitral regurgitation (MR) is a common and serious complication of ischemic heart disease. Three general forms are distinguished: MR related to acute rupture of the mitral pillar, ischemic MR and functional MR. Resume

Clinical, imaging, and pathological characteristics of left ventricular thrombus: A comparison of contrast-enhanced magnetic resonance imaging, transthoracic echocardiography, and transesophageal echocardiography with surgical or pathological validation

Left ventricular (LV) thrombus is a frequent and potentially dangerous complication of ischemic heart disease (IHD). We evaluated the clinical, imaging, and pathology characteristics of confirmed LV thrombus and compared the diagnostic value of contrast-enhanced magnetic resonance imaging (MRI) with transthoracic (TTE) and transesophageal echocardiography (TEE) for the diagnosis of LV thrombi. Between November 1997 and December 2003, 361 patients with IHD had surgical and/or pathological confirmation of presence or absence of LV thrombus. Clinical information and preoperative imaging study reports were retrospectively reviewed regarding detection of thrombus. Comparisons were made between clinical and imaging characteristics of patients with and without confirmed thrombus. Left ventricular thrombus was present in 106 (29%) of 361 patients in this study. Patients with thrombus had a higher incidence of recent embolic events (6.1% vs 0.8%, P < .005). In 160 patients with all 3 imaging modalities performed within 30 days of surgical or pathological confirmation, contrast-enhanced MRI showed the highest sensitivity and specificity (88% +/- 9% and 99% +/- 2%, respectively) compared with TTE (23% +/- 12% and 96% +/- 3.6%, respectively) and TEE (40% +/- 14% and 96% +/- 3.6%, respectively) for thrombus detection. Left ventricular thrombus occurs frequently in patients with IHD and is associated with risk of systemic embolization. Contrast-enhanced MRI provided the highest sensitivity and specificity for LV thrombus when compared to TTE and TEE, and should be considered in the care of patients at high risk of LV thrombus formation.

Relationship between adiponectin, glycemic control and blood lipids in diabetic type 2 postmenopausal women with and without complication of ischemic heart disease

Background Recently major adipocytokine, adiponectin, are thought to play important roles in the regulation of cardiovascular and metabolic homeostasis. We compared serum adiponectin concentrations and lipid profile in diabetic patients with and without complication of cardiovascular disease in postmenopausal women. Methods We included 120 female subjects between the age of 45 and 60 years. The subjects were divided into 3 groups and each group comprised of 40 subjects. First group comprised of normal healthy controls, second group diabetic type 2 patients with no history of ischemic heart disease (IHD) and the third group diabetic patients with IHD. Serum adiponectin concentrations, serum triglycerides, cholesterol, LDL cholesterol and HDL cholesterol concentrations were determined. Results Values of fasting and random blood glucose, serum triglycerides, cholesterol, LDL cholesterol were significantly increased ( P < 0.001) in diabetic patients with IHD as compared with normal control subjects except for serum adiponectin and HDL cholesterol concentrations, which were significantly decreased ( P < 0.001) in diabetic patients and diabetic patients with IHD group. When values of cholesterol, triglycerides, LDL cholesterol, HDL cholesterol, fasting and random blood glucose and adiponectin were compared among diabetic and diabetic patients with IHD, it was observed that they were significantly increased ( P < 0.001) except for adiponectin, which was decreased significantly ( P < 0.001) and random blood glucose, LDL and HDL cholesterol in which no change was observed between the 2 groups. Conclusions Serum adiponectin concentrations may be a predictor for development of cardiovascular disease in postmenopausal diabetic patients.

CLINICAL SIGNIFICANCE OF ASPIRIN RESISTANCE IN PATIENTS WITH CARDIO-VASCULAR DISEASES

Atherothrombosis is a complication of ischemic heart disease, and it leads to development of acute coronary syndrome. Atherothrombosis is characterized by sudden destruction of atherosclerotic plaque, which results into platelets activation and thrombus formation. Aspirin - one of the most widely used antiaggregate drugs, prevents development of the recurring myocardium infarction, stroke, sudden coronary death. But in number of patients aspirin is not efficient. Development of repeated thrombotic complications with aspirin therapy or resistance to aspirin is independent predictor of high coronary risk. There are controversial data about aspirin resistance incidence, which varies from 5 to 48%. Possible reasons for this are discussed: low compliance with treatment, peculiarities of functional condition of platelets, genetically given variability of platelet receptors etc. Different methods, based on estimation of platelets activity are proposed to assess the possibility of repeated thrombotic complications, caused by resistance to aspirin. Further researches including valid number of patients are needed to assess incidence of aspirin resistance and to reveal mechanisms of its development.

Ischemic Mitral Regurgitation: Impact of the Left Ventricle and Mitral Valve in Patients with Left Ventricular Systolic Dysfunction

Mitral regurgitation (MR) is a common complication of ischemic heart disease, and its presence portends adverse outcomes. As the exact mechanisms of ischemic MR are not well defined, we characterized left ventricular global geometry, regional function, and regional myocardial scarring, in addition to mitral valve apparatus geometry, using magnetic resonance imaging (MRI) of ischemic heart disease patients with left ventricular dysfunction and varying degrees of ischemic MR. Sixty patients with varying degrees of MR (none, mild, moderate, and severe) determined by echocardiography and referred for MRI assessment of ischemic heart disease were included. Left ventricular geometric, functional, and scar measurements in addition to mitral valve geometric measurements were evaluated. Clinical characteristics found to be significant predictors of degree of MR included severity of coronary artery disease (p < 0.05), completeness of myocardial perfusion (p < 0.005), and average systolic blood pressure (p < 0.05). Mitral systolic tenting area (p < 0.0001) in a statistical model with scarring of the anterior-lateral region (p < 0.05) proved to be the most powerful predictor of MR severity (r2 = 0.31). Mitral annular dilatation in the anterior-posterior direction (p < 0.0001) and diminished LV systolic function (p < 0.005) were important determinants of mitral systolic tenting area (r2 = 0.57). Mitral tenting in combination with regional left ventricular myocardial scarring are important mechanisms to the development of ischemic MR. Surgical annuloplasty addresses mitral tenting, but has little impact on the effect of regional scarring. Moderate-to-severe ischemic MR develops in patients with regional scarring of the anterior-lateral and inferior-posterior regions, and new surgical developments should take this into account.

Studies of fibrinogen binding to porcine platelets by flow cytometry: a method for studies of porcine platelet activation

Platelets have a central function in haemostasis. They also participate in arterial thrombus formation in vascular disorders. Platelets have an important role in initiating and mediating ischaemia and related complications of ischemic heart disease. Several research groups are thus studying platelet activation and developing new platelet inhibitors. Platelet function is dependent upon membrane receptors and their interaction with other proteins. Binding of fibrinogen to the platelet glycoprotein (GP) IIb/IIIa receptor is a prerequisite for platelet aggregation and thrombus formation. Thus, several GPIIb/IIIa inhibitors have been developed of which abciximab is the clinically most widely used. Pigs are often used for experimental studies. We have developed a flow cytometry assay for measuring porcine platelet activation utilising an FITC-labelled chicken anti-fibrinogen antibody. ADP, ristocetin and thrombin induce fibrinogen binding to porcine platelets similarly to human platelets. Ristocetin induces platelet aggregation and microvesicle formation from porcine platelets as well as from human platelets.

A critical pathway for management of patients with acute chest pain who are at low risk for myocardial ischemia: recommendations and potential impact.

Use of resources for patients with acute chest pain may be improved with clinical strategies that integrate research, Bayesian analysis, and expert opinion. To 1) develop a critical pathway for management of patients with acute chest pain who are at low risk for complications of ischemic heart disease and 2) assess the potential effects of implementation of the pathway on patient safety and resource use. Evidence-based consensus and prospective cohort study. Urban teaching hospital. Patients at least 30 years of age who were seen in the emergency department for chest pain and who did not have a history of trauma or abnormalities on radiologic study. Physician-opinion leaders defined criteria for patient inclusion in the pathway and for remaining on the pathway after 6 or 12 hours of observation. Criteria were defined for appropriateness of direct admission, direct discharge, or 6 hours of observation followed by exercise treadmill testing. Number of patients admitted to the hospital, number of days that patients were hospitalized, and clinical outcome. 2898 of 4585 patients (63%) were admitted to the hospital; of the 2898, 1152 (40%) were classified as potentially eligible for the pathway and 1068 (93%) had a benign clinical course during the initial observation period. The 1068 patients had a mean length of stay of 2.8 +/- 4.8 days. If 47% of these patients had been discharged after observation and exercise testing, implementation of the pathway would have reduced the number of admissions by 505 (17%) and days of hospitalization by 1407 (11%). Retrospective analysis suggests that a critical pathway for patients with acute chest pain may substantially reduce resource use. Prospective study is needed to ensure increased efficiency without increased adverse outcomes.

Cardiovascular disease in women.

Cardiovascular disease (CVD) is the leading cause of death in women. Clear gender differences exist in the incidence, prevalence, presentation, diagnosis, treatment, and prognosis of cardiovascular diseases. Over the past 15 years, robust efforts focused on the evidence-based prevention and treatment of CVD in women have resulted in a steeper decrease in cardiovascular (CV) mortality rates in women compared to men beginning in 2000. The prominent decline in female CV mortality rates is a new phenomenon, as decreases in male CV mortality rates outpaced those in women during the 1980s and 1990s. Historically, women have been underrepresented in clinical trials investigating cardiovascular diseases. Over the past decade, the representation of women in clinical trials has improved, and nuanced treatment approaches and prevention strategies have resulted from the dedicated study of gender differences. The traditional CV research focus has been on obstructive coronary disease and the development and complications of ischemic heart disease in men. Research has shown multiple layers of complexity in the etiology and pathophysiology of cardiovascular diseases in women differing from those predominating in men. Investigation has also shown a relationship between the hormonal fluctuations women experience throughout life and the development of ischemic heart disease and arrhythmias. Therefore, cardiovascular disease processes in women should not be equated to those traditionally encountered in the male population, and these differences should alter the physicians’ approach to the female patient.

Essential Hypertension: A Critical Point of View

Trials of antihypertensive therapy in mild hypertension find a reduction in cardiovascular events favoring active or drug intervention. A critical review of this evidence offers little justification for uniformly treating all of these patients. While the reduction in cardiovascular events is statistically significant, the absolute numerical reduction is much less impressive. Antihypertensive drug treatment does not appear to reduce complications of ischemic heart disease. Furthermore, drug therapy, while improving, causes a good deal of morbidity. Consequently, I advocate and have outlined a less aggressive approach to managing the asymptomatic patient with mild hypertension.

AIV-13 虚血性心疾患の合併症に対する外科治療とその遠隔成績

AIV-13 虚血性心疾患の合併症に対する外科治療とその遠隔成績

AIV-15 虚血性心疾患,とくに心筋梗塞後合併症に対する外科療法の検討

AIV-15 虚血性心疾患,とくに心筋梗塞後合併症に対する外科療法の検討

AIV-17 虚血性心疾患の合併症に対する外科治療

AIV-17 虚血性心疾患の合併症に対する外科治療

Ventricular Septal Rupture and Mitral Regurgitation in a Patient with an Acute Myocardial Infarction: Clinical Conference in Cardiology from the Departments of Medicine and Surgery, Emory University School of Medicine and Grady Memorial Hospital, Atlanta

Dr. Daniel Arensberg: Ventricular septal defect after infarction is a rare and highly lethal complication of acute myocardial infarction. The incidence of this mechanical complication is approximately 1 to 2 percent and results in a mortality of up to 80 percent with medical therapy alone.1 Acute severe mitral regurgitation occurring in the setting of acute myocardial infarction is another ominous complication of ischemic heart disease.2 The incidence of these two lesions in the same patient with acute myocardial infarction is unknown.