Endothelial dysfunction has been attributed to reduced production of endothelial nitric oxide (NO) production, and thus affects vasoreactivity and smooth muscle cell growth, platelet reactivity and leucocyte adhesion to the endothelium.
Reduced production and bioavailability of NO can be caused by several mechanisms, one being increased production and/or accumulation of the amino acid asymmetric dimethylarginine (ADMA). ADMA is an endogenous competitive inhibitor of nitric oxide synthase (NOS),
Recent studies have demonstrated that newly diagnosed glucose intolerance is common among patients with acute myocardial infarction (AMI). The purpose of this study was to assess the long-term clinical cardiovascular outcomes in participants with AMI with abnormal fasting glucose compared with normal fasting glucose and an abnormal oral glucose tolerance test (OGTT) compared with a normal OGTT.
A prospective study was performed in 275 consecutive patients with AMI, 85 of whom had pre-diagnosed diabetes mellitus (DM). Those without DM were divided into two groups based on the 75 g OGTT at the time of discharge. Abnormal glucose tolerance (AGT) was defined as 2 h glucose ≥140 mg/dl; 78 patients had normal glucose tolerance (NGT) and 112 had AGT. The same patients were also reclassified into the normal fasting glucose group (NFG; n=168) or the impaired fasting glucose group (IFG; n=22). The association between the glucometabolic status and long-term major adverse cardiovascular event rates was evaluated.
Kaplan–Meier survival curves showed that the AGT group had a worse prognosis than the NGT group and an equivalent prognosis to the DM group (p<0.0005). Cox proportional hazard model analysis showed that the HR of AGT to NGT for major adverse cardiovascular event rates was 2.65 (95% CI 1.37 to 5.15, p=0.004) while the HR of DM to NGT was 3.27 (1.68 to 6.38, p=0.0005). However, Cox HR of IFG to NFG for major adverse cardiovascular event rates was 1.83 (0.86 to 3.87), which was not significant.
In patients with AMI, an abnormal OGTT is a better risk factor for future adverse cardiovascular events than impaired fasting blood glucose.
The purpose of this study was to investigate the hypothesis that responses to the ATP test and head-up tilt test (HUT) may be correlated with different purinergic profiles.
The ATP and HUT identify distinct subsets of patients with neurally mediated syncope (NMS). Adenosine and its A2A receptors (A2AR) may be implicated in the pathophysiology of NMS in patients with positive HUT. Nothing is known about the purinergic profile of patients with positive ATP.
This prospective study includes a consecutive series of patients with suspected NMS. All patients underwent both HUT and ATP. Before testing, samples were collected for measurement of baseline adenosine plasma level (APL) and expression.
A total of 46 patients (25 men and 21 women) with a mean age of 57±18 years were enrolled. The HUT test was positive in 27 patients and the ATP test in 20. Both tests were positive in 9 and negative in 8. High APL was associated with high probability of positive HUT while low APL was associated with high probability of positive ATP. Expression of A2AR was lower in patients with positive ATP than in those with positive HUT.
These findings indicate that patients with NMS present different purinergic profiles and that responses to HUT and ATP are correlated with these profiles.
To investigate the prognostic value of circulating levels of asymmetric dimethylarginine (ADMA) in patients with acute decompensation of (New York Heart Association (NYHA) class III/IV) chronic heart failure and reduced left ventricular ejection fraction.
Single-centre prospective observational study.
Tertiary referral centre.
A total of 651 consecutive and eligible hospitalised patients were studied. Patients were divided into four groups according to the quartiles of circulating levels of ADMA upon presentation.
Incidence of in-hospital (or 7-day in the case of prolonged hospitalisation), 31-day and 1-year cardiac mortality were the pre-specified study end points.
Cumulative rates of in-hospital, 31-day and 1-year cardiac mortality were 10.6%, 18.7% and 36.4%, respectively. There was a gradual increased risk of in-hospital (pfor trend=0.011), 31-day (pfor trend=0.044) and 1-year (pfor trend<0.001) mortality with increasing ADMA quartiles. After adjustment for possible confounders, patients at the highest ADMA quartile were at significantly higher risk for in-hospital (p=0.042), 31-day (p=0.032) and 1-year (p<0.001) mortality than those in the lowest quartile.
According to the present results, an elevated circulating level of ADMA is a strong independent predictor of short-term and long-term mortality in patients with acute decompensation of NYHA class III/IV chronic heart failure and reduced left ventricular ejection fraction. ADMA levels upon presentation may confer enhanced risk stratification in this setting.
To determine in patients with coronary heart disease (CHD) and people at high risk of developing cardiovascular disease (CVD) whether the Joint British Societies' guidelines on CVD prevention (JBS2) are followed in everyday clinical practice.
A cross-sectional survey was undertaken of medical records and patient interviews and examinations at least 6 months after the recruiting event or diagnosis using standardised instruments and a central laboratory for measurement of lipids and glucose.
The ASPIRE-2-PREVENT survey was undertaken in 19 randomly selected hospitals and 19 randomly selected general practices in 12 geographical regions in England, Northern Ireland, Wales and Scotland.
In hospitals, 1474 consecutive patients with CHD were identified and 676 (25.6% women) were interviewed. In general practice, 943 people at high CVD risk were identified and 446 (46.5% women) were interviewed.
The prevalence of risk factors in patients with CHD and high-risk individuals was, respectively: smoking 14.1%, 13.3%; obesity 38%, 50.2%; not reaching physical activity target 83.3%, 85.4%; blood pressure ≥130/80 mm Hg (patients with CHD and self-reported diabetes) or ≥140/85 mm Hg (high-risk individuals) 46.9%, 51.3%; total cholesterol ≥4 mmol/l 52.6%, 78.7%; and diabetes 17.8%, 43.8%.
The potential among patients with CHD and individuals at high risk of developing CVD in the UK to achieve the JBS2 lifestyle and risk factor targets is considerable. CVD prevention needs a comprehensive multidisciplinary approach, addressing all aspects of lifestyle and risk factor management. The challenge is to engage and motivate cardiologists, physicians and other health professionals to routinely practice high quality preventive cardiology in a healthcare system which must invest in prevention.
To construct a risk score out of baseline variables to estimate the risk of death without prior implantable cardioverter defibrillator (ICD) in primary prevention ICD patients with ischaemic heart disease.
Retrospective cohort study.
Tertiary care facility in The Netherlands.
All patients with ischaemic heart disease who received an ICD for primary prevention of sudden cardiac death at the Leiden University Medical Center, Leiden, The Netherlands in the period 1996–2009.
All-cause mortality without prior appropriate ICD therapy (anti-tachycardia pacing or shock).
900 patients (87% men, mean age 64±10 years) were included in the analysis. During a median follow-up of 669 days (IQR 363–1322 days), 150 patients (17%) died and 191 (21%) patients received appropriate device therapy. 114 (13%) patients died without prior appropriate therapy. Stratification of the risk for death without prior appropriate therapy resulted in risk categorisation of patients as low, intermediate or high risk. NYHA ≥III, advanced age, diabetes mellitus, left ventricular ejection fraction ≤25% and a history of smoking were significant independent predictors of death without appropriate ICD therapy. 5-year cumulative incidence for death without prior appropriate therapy ranged from 10% (95% CI 6% to 16%) in low-risk patients to 41% (95% CI 33% to 51%) in high-risk patients.
The risk of death without prior appropriate ICD therapy can be predicted in primary prevention ICD patients with ischaemic heart disease, which facilitates patient-tailored risk estimation.
In spite of recent advances in the treatment of patients with end stage heart failure, heart transplantation (HTx) still remains the best option for patients under 70 years of age suffering from this condition. It provides not only a dramatic change in expected survival, unequalled by any other intervention, but also a substantial improvement in the quality of life of patients.
According to the Global Observatory on Donation and Transplantation, approximately 100 000 solid organ transplants are performed every year in the world, 5000 of which are HTx.
Whist epinephrine (epinephrine) is commonly used during cardiopulmonary resuscitation, both in and out of hospital, its effectiveness is poorly established. Although some animal studies have suggested a short term benefit due to increased cerebral and coronary perfusion, an increase in myocardial oxygen consumption and ventricular arrhythmias has also been documented. The purpose of this analysis was to determine how the use of epinephrine in cardiopulmonary resuscitation performed before hospital arrival (out-of-hospital arrest) was associated with immediate and 1-month survival.
The study was a prospective, non-randomised, observational propensity analysis of data from 417 188 out-of-hospital cardiac arrests in Japan between 2005 and 2008. The main outcome measures were the return of spontaneous circulation before hospital arrival, survival at one month after cardiac arrest, survival with good or moderate cerebral performance, and survival with no, mild, or only moderate neurological disability. Outcomes were compared between...]]>
On that point of genuineness, rarely do my colleagues ask the patient whether that relative who suffered a heart attack in their 50s smoked or had diabetes. The ‘positive family history’ of CAD...]]>
We agree that the INTERHEART study shows that a combination of nine risk factors accounts for 90% of the population attributable risk for myocardial infarction, which did not include family history. However, even in the INTERHEART study, family history was an independent risk factor for myocardial...]]>
Clinical pulmonary vein stenosis was 0.17%. Persistent phrenic nerve palsy beyond one year occurred in only 0.37%. It is also a very simple technique not involving any ancillary technology such as angioscopy and no additional certification is required (in the UK, laser training and certification...]]>
First, Dr Ward points out that my comments may be biased because I have a ‘vested interest’ in the laser balloon. It should be noted that while I have received an investigator initiated research grant to perform preclinical work with the laser balloon (as declared in the editorial), I have no other consulting role with the company nor have I received any payment for work with the company. As a physician who spends a large part of my time performing atrial fibrillation (AF) ablations, my main goal is to help develop any...]]>