Results Generated From:
Embase <1980 to 2011 Week 21>
Embase (updates since 2011-05-19)
<1>
Accession Number
2011251322
Authors
Ferguson C.D. Buettner P.G. Golledge J.
Institution
(Ferguson, Golledge) Department of Surgery, School of Medicine and
Dentistry, James Cook University, Townsville, QLD, Australia
(Buettner) School of Public Health, Tropical Medicine and Rehabilitation
Sciences, James Cook University, Townsville, QLD, Australia
Title
Regarding "a meta-analysis of clinical studies of statins for prevention
of abdominal aortic aneurysm expansion".
Source
Journal of Vascular Surgery. 53 (5) (pp 1452-1453), 2011. Date of
Publication: May 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
<2>
Accession Number
2011258428
Authors
Brenner R. Waeber B. Allemann Y.
Institution
(Brenner, Allemann) Cardiology, Swiss Cardiovascular Centre Bern,
University Hospital Bern, CH-3010 Bern, Switzerland
(Waeber) Division of Pathophysiology, Centre Hospitalier Universitaire
Vaudois, University Hospital Lausanne, Switzerland
Title
Medical treatment of hypertension in Switzerland: The 2009 Swiss
Hypertension Survey (SWISSHYPE).
Source
Swiss Medical Weekly. 141 (MARCH) , 2011. Date of Publication: March
2011.
Publisher
EMH Swiss Medical Publishers Ltd. (Steinentorstrasse 13, Basel CH-4010,
Switzerland)
Abstract
OBJECTIVES: Despite a broad and efficient pharmacological antihypertensive
armamentarium, blood pressure (BP) control is suboptimal and heterogeneous
throughout Europe. Recent representative data from Switzerland are
limited. The goal of the present survey was therefore to assess the actual
control rate of high BP in Switzerland in accordance with current
guidelines. The influence of risk factors, target organ damage and
medication on BP levels and control was also evaluated. METHODS: A
cross-sectional visit-based survey of ambulatory hypertensive patients was
performed in 2009 in Switzerland. 281 randomly selected physicians
provided data on 5 consecutive hypertensive patients attending their
practices for BP follow-up. Data were anonymously collected on
demographics, comorbidities and current medication, and BP was recorded.
Subsequent modification of pharmacological antihypertensive therapy was
assessed. RESULTS: Data from 1376 patients were available. Mean age was 65
+/- 12 years, 53.9% were male subjects. 26.4% had complicated
hypertension. Overall, BP control (<140/90 mm Hg for uncomplicated and
<130/80 mm Hg for complicated hypertension) was achieved in 48.9%.
Compared to patients with complicated hypertension, BP control was better
in patients with uncomplicated hypertension (59.4% vs. 19.2%, p <0.001).
As a monotherapy the most prescribed drug class were angiotensin receptor
blockers (ARB, 41%), followed by angiotensin converting enzyme (ACE)
inhibitors (21.5%), betablockers (20.8%) and calcium channel blockers
(CCB, 10.8%). The most prescribed drug combinations were ARB + diuretic
(30.1%) and ACE inhibitors + diuretic (15.3%). 46% were receiving a fixed
drug combination. In only 32.7% of patients with uncontrolled hypertension
was a change in drug therapy made. CONCLUSION: This representative survey
on treated adult hypertensive patients shows that, compared to earlier
reports, the control rate of hypertension has improved in Switzerland for
uncomplicated but not for complicated, particularly diabetes-associated
hypertension. ARBs and ACE inhibitors are the most prescribed
antihypertensive drugs for monotherapy, whereas diuretics and ARBs were
the most used for combination therapy.
<3>
Accession Number
2011258086
Authors
Wang B. Raedschelders K. Shravah J. Hui Y. Safaei H.G. Chen D.D.Y. Cook
R.C. Fradet G. Au C.L. Ansley D.M.
Institution
(Wang, Raedschelders, Shravah, Safaei, Au, Ansley) UBC, Department of
Anesthesiology, Pharmacology and Therapeutics, 2176 Health Sciences Mall,
Vancouver, BC V6T 1Z3, Canada
(Hui, Chen) Departments of Chemistry, Faculty of Medicine, University of
British Columbia, Vancouver, BC, Canada
(Cook, Fradet) Departments of Cardiac Surgery, Faculty of Medicine,
University of British Columbia, Vancouver, BC, Canada
Title
Differences in myocardial PTEN expression and Akt signalling in type 2
diabetic and nondiabetic patients undergoing coronary bypass surgery.
Source
Clinical Endocrinology. 74 (6) (pp 705-713), 2011. Date of Publication:
June 2011.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Objective Patients with diabetes experience increased cardiovascular
complications after cardiac surgery. Hyperglycaemia predicts increased
mortality after myocardial infarction and may influence cardiovascular
risk in humans. Impaired prosurvival phosphatase and tensin homologue on
chromosome 10 (PTEN)-Akt signalling could be an important feature of the
diabetic heart rendering it resistant to preconditioning. This study was
designed to evaluate for differences and relationships of myocardial
PTEN-Akt-related signalling and baseline glycaemic control marker in type
2 diabetic and nondiabetic patients undergoing coronary artery bypass
surgery. Methods Right atrial biopsies and coronary sinus blood were
obtained from 18 type 2 diabetic and 18 nondiabetic patients
intraoperatively. Expression and phosphorylation of Akt, endothelial
nitric oxide synthase (eNOS), Bcl-2 and PTEN were evaluated by Western
blot. Plasma 15-F<sub>2t</sub>-isoprostane concentrations were evaluated
by liquid chromatography-mass spectrometry. Results PTEN expression and
15-F <sub>2t</sub>-isoprostane concentrations were significantly higher in
diabetic patients. Increased fasting blood glucose levels correlated with
increased coronary sinus plasma 15-F<sub>2t</sub>-isoprostane
concentrations. Increased cardiac 15-F<sub>2t</sub>-isoprostane generation
was highly correlated with myocardial PTEN expression. Bcl-2 expression
and eNOS phosphorylation were significantly lower in diabetic compared
with nondiabetic patients. Akt phosphorylation tended to be lower in
diabetic patients; however, this tendency failed to reach statistical
significance. Conclusion The current results suggest that prosurvival
PTEN-Akt signalling is impaired in the diseased diabetic myocardium.
Hyperglycaemia and increased oxidative stress may contribute to this
phenomenon. These findings strengthen the understanding of the underlying
biologic mechanisms of cardiac injury in diabetic patients, which could
facilitate development of new treatments to prevent cardiovascular
complications in this high-risk population. 2011 Blackwell Publishing
Ltd.
<4>
Accession Number
2011252171
Authors
Park S.-J. Kim Y.-H. Park D.-W. Yun S.-C. Ahn J.-M. Song H.G. Lee J.-Y.
Kim W.-J. Kang S.-J. Lee S.-W. Lee C.W. Park S.-W. Chung C.-H. Lee J.-W.
Lim D.-S. Rha S.-W. Lee S.-G. Gwon H.-C. Kim H.-S. Chae I.-H. Jang Y.
Jeong M.-H. Tahk S.-J. Seung K.B.
Institution
(Park, Kim, Park, Ahn, Song, Lee, Kim, Kang, Lee, Lee, Park, Chung, Lee)
Heart Institute, Seoul, South Korea
(Yun) Division of Biostatistics, Center for Medical Research and
Information, University of Ulsan College of Medicine, Seoul, South Korea
(Lim) Korea University Anam, Seoul, South Korea
(Rha) Guro Hospitals, Seoul, South Korea
(Gwon) Samsung Medical Center, Seoul, South Korea
(Kim) Seoul National University Hospital, Seoul, South Korea
(Jang) Yonsei University Severance Hospital, Seoul, South Korea
(Seung) Catholic University of Korea, St. Mary's Hospital, Seoul, South
Korea
(Lee) Ulsan University Hospital, Ulsan, South Korea
(Chae) Seoul National University Hospital, Bundang, South Korea
(Jeong) Chonnam National University Hospital, Gwangju, South Korea
(Tahk) Ajou University Medical Center, Suwon, South Korea
(Park) Heart Institute, Asan Medical Center, University of Ulsan, 388-1
Pungnap-dong, Songpa-gu, Seoul, 138-736, South Korea
Title
Randomized trial of stents versus bypass surgery for left main coronary
artery disease.
Source
New England Journal of Medicine. 364 (18) (pp 1718-1727), 2011. Date of
Publication: 05 May 2011.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is increasingly used
to treat unprotected left main coronary artery stenosis, although
coronary-artery bypass grafting (CABG) has been considered to be the
treatment of choice. METHODS We randomly assigned patients with
unprotected left main coronary artery stenosis to undergo CABG (300
patients) or PCI with sirolimus-eluting stents (300 patients). Using a
wide margin for noninferiority, we compared the groups with respect to the
primary composite end point of major adverse cardiac or cerebrovascular
events (death from any cause, myocardial infarction, stroke, or
ischemia-driven target-vessel revascularization) at 1 year. Event rates at
2 years were also compared between the two groups. RESULTS The primary end
point occurred in 26 patients assigned to PCI as compared with 20 patients
assigned to CABG (cumulative event rate, 8.7% vs. 6.7%; absolute risk
difference, 2.0 percentage points; 95% confidence interval [CI], -1.6 to
5.6; P = 0.01 for noninferiority). By 2 years, the primary end point had
occurred in 36 patients in the PCI group as compared with 24 in the CABG
group (cumulative event rate, 12.2% vs. 8.1%; hazard ratio with PCI, 1.50;
95% CI, 0.90 to 2.52; P = 0.12). The composite rate of death, myocardial
infarction, or stroke at 2 years occurred in 13 and 14 patients in the two
groups, respectively (cumulative event rate, 4.4% and 4.7%, respectively;
hazard ratio, 0.92; 95% CI, 0.43 to 1.96; P = 0.83). Ischemia-driven
target-vessel revascularization occurred in 26 patients in the PCI group
as compared with 12 patients in the CABG group (cumulative event rate,
9.0% vs. 4.2%; hazard ratio, 2.18; 95% CI, 1.10 to 4.32; P = 0.02).
CONCLUSIONS In this randomized trial involving patients with unprotected
left main coronary artery stenosis, PCI with sirolimus-eluting stents was
shown to be noninferior to CABG with respect to major adverse cardiac or
cerebrovascular events. However, the noninferiority margin was wide, and
the results cannot be considered clinically directive. (Funded by the
Cardiovascular Research Foundation, Seoul, Korea, and others; PRECOMBAT
ClinicalTrials.gov number, NCT00422968.) Copyright 2011 Massachusetts
Medical Society. All rights reserved.
<5>
Accession Number
2011248635
Authors
Carvalho G. Pelletier P. Albacker T. Lachapelle K. Joanisse D.R.
Hatzakorzian R. Lattermann R. Sato H. Marette A. Schricker T.
Institution
(Carvalho, Hatzakorzian, Lattermann, Sato, Schricker) Department of
Anesthesia, McGill University, Montreal, QC H3A 1A1, Canada
(Pelletier) Department of Pharmacology, Universite de Montreal, Montreal,
QC H3T 1J4, Canada
(Marette) Research Center Laval University, Lipid Research Unit, QC G1V
0A6, Canada
(Joanisse) Division of Kinesiology, Laval University, QC G1V 0A6, Canada
(Albacker, Lachapelle) Department of Cardiac Surgery, McGill University,
Montreal, QC H3A 1A1, Canada
Title
Cardioprotective effects of glucose and insulin administration while
maintaining normoglycemia (GIN therapy) in patients undergoing coronary
artery bypass grafting.
Source
Journal of Clinical Endocrinology and Metabolism. 96 (5) (pp 1469-1477),
2011. Date of Publication: May 2011.
Publisher
Endocrine Society (8401 Connecticut Ave. Suite 900, Chevy Chase MD 20815,
United States)
Abstract
Context: Coronary artery bypass grafting (CABG) is complicated by
ischemia-reperfusion injury jeopardizing myocyte survival. Objective: The
aim of the study was to investigate whether glucose and insulin
administration, while maintaining normoglycemia (GIN therapy) using a
hyperinsulinemic-normoglycemic clamp technique, is cardioprotective in
patients undergoing CABG. Design and Setting: We conducted a randomized
controlled trial at a tertiary care university teaching hospital.
Patients: We studied 99 patients undergoing elective CABG. Intervention:
Patients were randomly assigned to receive either GIN from the beginning
of surgery until 24 h after CABG (GIN, n = 49) or standard metabolic care
(control, n = 50). Main Outcome Measures: We measured plasma
concentrations of cardiac troponin I and free fatty acids, cardiac
function as assessed by transesophageal echocardiography, glycogen
content, glycogen synthase activity, and the expression of AMP-activated
protein kinase (AMPK) and protein kinase B (AKT) in cardiomyocytes.
Results: Patients receiving GIN therapy showed an attenuated release of
cardiac troponin I (P < 0.05) and improved myocardial function (P < 0.05).
Systemic free fatty acid concentrations were suppressed (P < 0.05),
whereas intracellular glycogen contentandglycogen synthase activitywerenot
altered. The AMPK activity remained unchanged during ischemia in the GIN
group, whereas it increased in the control group (P < 0.05). Enhanced AKT
phosphorylation before ischemia was observed (P < 0.05) in the presence of
GIN. However, there was no evidence for AKT-dependent AMPK inhibition.
Conclusions: GIN therapy protects the myocardium and inhibits
ischemia-induced AMPK activation. Copyright 2011 by The Endocrine
Society.
<6>
Accession Number
2011264136
Authors
Tamorgo J. Lopez-Farre A. Caballero R. Delpon E.
Institution
(Tamorgo, Lopez-Farre, Caballero, Delpon) Department of Pharmacology,
School of Medicine, Universidad Complutense, 28040 Madrid, Spain
Title
Dronedarone.
Source
Drugs of Today. 47 (2) (pp 109-133), 2011. Date of Publication: February
2011.
Publisher
Prous Science (P.O. Box 540, Barcelona 08080, Spain)
Abstract
Atrial fibrillation (AF), the most common cardiac arrhythmia, is
associated with substantial morbidity and mortality. Dronedarone is an
amiodarone-like benzofuran which lacks the iodine moiety and presents a
methane sulfonyl group that decreases its lipophilicity, thus shortening
the half-life and decreasing tissue accumulation. Like amiodarone,
dronedarone blocks multiple cardiac ion channels and beta-adrenoceptors,
presenting electrophysiological characteristics of all four Vaughan
Williams classes of antiarrhythmic drugs. In clinical trials, dronedarone
has been found effective for both rhythm and rate control. Dronedarone was
more effective than placebo in maintaining sinus rhythm in patients with
paroxysmal and/or persistent AF and was also effective for ventricular
rate control during AF recurrences, providing incremental rate control on
top of standard drugs in permanent AF. Furthermore, in the ATHENA trial,
dronedarone reduced the incidence of hospitalization due to cardiovascular
events or death in patients with nonpermanent AF. Even when dronedarone
was less effective than amiodarone in decreasing AF recurrence, it had a
better safety profile, being devoid of thyroid, pulmonary and neurological
toxicity. This review analyzes the electrophysiological and
pharmacological properties, as well as the efficacy and safety of
dronedarone in patients with atrial fibrillation. Copyright 2011 Prous
Science, S.A.U. or its licensors. All rights reserved.
<7>
Accession Number
2011251464
Authors
Ormiston J.A. Turco M.A. Hall J.J. Cannon L.A. Yakubov S.J. Lucca M.J.
Stone G.W. O'Shaughnessy C.D. Kozina J.A. Gilchrist I.C. Bertolet B.D.
Worthley S.G. Underwood P.L. Dawkins K.D.
Institution
(Ormiston) Mercy Angiography Unit, Mercy Hospital, Auckland, New Zealand
(Turco) Center for Cardiac and Vascular Research, Washington Adventist
Hospital, Takoma Park, MD, United States
(Hall) The Heart Center, St Vincent's Hospital, Indianapolis, IN, United
States
(Cannon) Cardiac and Vascular Research Center, Northern Michigan Regional
Health Systems, Petoskey, MI, United States
(Yakubov) Ohio Health Research Institute, Riverside Methodist Hospital,
Columbus, OH, United States
(Lucca) Department of Education and Research, St Mary's Duluth Clinic
Regional Heart Center, Duluth, MN, United States
(Stone) Center for Interventional Vascular Therapy, Columbia University
Medical Center, New York, NY, United States
(O'Shaughnessy) North Ohio Research, Elyria Memorial Hospital, Elyria, OH,
United States
(Kozina) Mercy Heart and Vascular Institute, Mercy General Hospital,
Sacramento, CA, United States
(Gilchrist) Heart and Vascular Institute, Milton S Hershey Medical Center,
Hershey, PA, United States
(Bertolet) Cardiology Associates of North Mississippi, North Mississippi
Medical Center, Tupelo, MS, United States
(Worthley) University of Adelaide, Royal Adelaide Hospital, Adelaide, SA,
Australia
(Underwood, Dawkins) Boston Scientific Corporation, Natick, MA, United
States
Title
Long-term benefit of the TAXUS liberte stent in small vessels and long
lesions - TAXUS ATLAS program.
Source
Circulation Journal. 75 (5) (pp 1120-1129), 2011. Date of Publication:
May 2011.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
Background: The long-term impact of treating de novo coronary lesions in
native vessels and challenging small vessel and long lesion subsets with
TAXUS Liberte stents is unknown. This report examines the 3-year efficacy
and safety from the TAXUS ATLAS program. Methods and Results: TAXUS ATLAS
WH, Small Vessel, and Long Lesion are non-randomized studies comparing
TAXUS Liberte (n=871), TAXUS Liberte 2.25 mm (n=261), and TAXUS Liberte 38
mm (n=150) stents, respectively, to case-matched TAXUS Express historical
controls. TAXUS Liberte demonstrated comparable 3-year rates of major
adverse cardiac events (19.0% vs. 20.2%, P=0.51) in de novo lesions,
reduced target lesion revascularization (TLR, 10.0% vs. 22.1%, P=0.008) in
small vessels, and reduced myocardial infarction (MI, 2.9% vs. 10.4%;
P=0.01) and stent thrombosis (ST, 0.0% vs. 3.9%, P=0.03) in long lesions
vs. TAXUS Express. After propensity score adjustment, no statistically
significant effect of TAXUS Liberte on TLR (9.7% vs. 16.9%, P=0.12) in
small vessels or MI (2.9% vs. 7.9%, P=0.05) in long lesions was noted,
although reduced ST (0.0% vs. 2.7%, P=0.02) remained in long lesions.
Multivariate analyses demonstrated that TAXUS Liberte treatment
significantly reduced TLR by 66% in small vessels, and MI by 75% in long
lesions, vs. TAXUS Express. Conclusions: TAXUS Liberte suggests durable
3-year effectiveness in reducing restenosis and improved clinical outcomes
in small vessels and long lesions compared with TAXUS Express.
<8>
Accession Number
2011252049
Authors
Meyer S. Gortner L. Brown K. Abdul-Khaliq H.
Institution
(Meyer, Gortner) Department of Neonatal, Paediatric Intensive Care
Medicine, University Hospital of Saarland, Homburg, Germany
(Brown) Cardiac Intensive Care Unit, Great Ormond Street Hospital, London,
University College, London, United Kingdom
(Meyer, Abdul-Khaliq) Department of Pediatric Cardiology, University
Hospital of Saarland, Building 9, 66421 Homburg, Germany
Title
The role of milrinone in children with cardiovascular compromise: Review
of the literature.
Source
Wiener Medizinische Wochenschrift. 161 (7-8) (pp 184-191), 2011. Date of
Publication: April 2011.
Publisher
Springer Wien (Sachsenplatz 4-6, P.O. Box 89, Vienna A-1201, Austria)
Abstract
Background: Cardiovascular instability is a common complication in
children after cardiac surgery and in various forms of shock. Methods:
Systematic literature review. Results: Four randomized controlled trials
(RCTs) were included in this systematic literature review. In children
after corrective surgery for congenital heart disease milrinone
significantly reduced the risk of development of LCOS compared with
placebo. In another study in children with high pulmonary vascular
resistance and impaired oxygenation after Fontan operation, inhalation of
NO with milrinone led to the most significant reduction of pulmonary
vascular resistance and improvement of oxygenation. When only milrinone
was given these changes were less pronounced. In non-hyperdynamic septic
shock, CI, SVI, and DO<sub>2</sub> significantly increased while SVRI
significantly decreased after milrinone when compared to placebo.
Conclusions: There are a limited number of RCTs in children that suggest a
beneficial effect of milrinone in the optimization of cardiovascular
function after cardiac surgery and in septic shock. 2011 Springer-Verlag.
<9>
Accession Number
2011264186
Authors
Szczeklik W. Morawski W. Sanak M. Jakiela B. Bolkowski M. Cisowski M.
Szczeklik M. Bochenek A. Musial J.
Institution
(Szczeklik, Sanak, Jakiela, Musial) 2nd Department of Medicine,
Jagiellonian University Medical Collage, Krakow, Poland
(Morawski, Bolkowski, Cisowski, Szczeklik, Bochenek) 1St Department of
Cardiac Surgery, Medical University of Silesia, Katowice, Poland
Title
A single dose of aprotinin prevents platelet hyporeactivity after coronary
artery bypass graft surgery.
Source
Polskie Archiwum Medycyny Wewnetrznej. 120 (9) (pp 321-327), 2010. Date
of Publication: 2010.
Publisher
Medycyna Praktyczna (31-066 Krakow31-066Poland)
Abstract
INTRODUCTION: Bleeding after coronary artery bypass graft (CABG) surgery
is associated with a significant increase in mortality. Even though
aprotinin significantly reduces bleeding in patients undergoing cardiac
surgery, its use has been recently substantially limited because of
serious cardiovascular complications. The exact mechanism of its action,
particularly its effect on platelet function, remains unclear. OBJECTIVES:
The aim of the study was to assess the effect of aprotinin on platelet
function in patients undergoing CABG. PATIENTS AND METHODS: In a
randomized placebo-controlled double-blind study, we investigated the
effect of a single dose of aprotinin on platelet function in 24 patients
who underwent CABG between 2005 and 2006. Before surgery and in the
postoperative period, we measured platelet activation markers (P-selectin
and activated form of glycoprotein IIb/IIIa) at baseline and following in
vitro platelet activation with adenosine diphosphate (ADP) or
protease-activated receptor 1 (PAR-1) agonist - thrombin receptor
activator for peptide 6 (TRAP-6). Perioperative bleeding and urinary
metabolites of thromboxane A<sub>2</sub> were also determined. RESULTS:
Aprotinin reduced perioperative bleeding by 26% (P <0.01) and prevented a
decrease in platelet sensitivity to ADP immediately after CABG. In vitro
platelet reactivity to TRAP-6 remained unchanged. Aprotinin did not affect
blood platelet count or urinary thromboxane A2 metabolite excretion after
CABG. CONCLUSIONS: Our results indicate that aprotinin may reduce
perioperative bleeding by its interference with ADP pathway of platelet
activation, thereby preventing postoperative hyporeactivity of platelets
to ADP. Platelet reactivity to PAR-1 receptor agonist was not affected by
aprotinin. Copyright by Medycyna Praktyczna, 2010.
<10>
Accession Number
70415790
Authors
Mohl W. Gittenberger De Groot A.C. Poelann R.E. Syeda B. Kasahara H.
Weigel G. Milasinovic D. De Jonge M. Komamura K. Khazen C. Jusic A. Heinze
G.
Institution
(Mohl, Weigel, Milasinovic, Khazen, Jusic, Heinze) Medical University of
Vienna, Austria
(Gittenberger De Groot, Poelann, Syeda, De Jonge) Anatomy Leiden
University Netherlands, Research Center, Netherlands
(Komamura) Research Institute, National Cardiovascular Center, Japan
(Kasahara) Keio University, Japan
Title
The atos trial, regenerative potential of PICSO in heart failure patients:
Experimental results and first-in-human use experiences.
Source
Heart Surgery Forum. Conference: 7th International Congress of Update in
Cardiology and Cardiovascular Surgery in Association with TCT
Mediterranean Antalya Turkey. Conference Start: 20110324 Conference End:
20110327. Conference Publication: (var.pagings). 14 (pp S11-S12), 2011.
Date of Publication: February 2011.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
OBJECTIVE: Periodic coronary venous pressure elevation initiates
regeneration opening new opportunities in the quest for myocardial
recovery. OBJECTIVES: We introduce a clinically feasible concept of
activating innate regenerative molecular pathways using coronary venous
hemodynamics as adjunctive therapy in patients undergoing
resynchronization therapy. METHODS: We compared experimental and clinical
data on pressure controlled intermittent coronary sinus occlusion (PICSO)
in order to translate this innovative concept into clinical practice.
RESULTS: Meta-analysis of the salvage potential of different intermittent
coronary sinus occlusion techniques revealed a significant reduction in
infarct size of 29.3% in different species during experimental myocardial
ischemia (p<.001). An inverse relationship between coronary sinus pressure
increase and infarct size (r=-0.92; p<.007) indicates that the hemodynamic
force of venous blood and its mechanotransduction results in salvage,
cytoprotection and enhanced collateral flow. Subsequent experiments showed
changes in gene expression pattern marked by a 4 fold increase
hemeoxygenase-1 expression (p<.001) in the center of infarction and a 2.5
fold increase of vascular endothelial growth factor (VEGF) (p<.002) in
border zones in treated animals compared to controls. Hypoxia induced
factor (HIF) activity however remained unchanged by PICSO suggesting an
independent regenerative stimulus. Furthermore we found a marked
upregulation of VEGF and VEGF-receptor 2 protein in the capillary
endothelial cells in remote areas in 86% of the PICSO treated hearts and
only in 43% of the non PICSO hearts. Clinical significance has been
confirmed by significant myocardial salvage and event free survival in
patients with acute myocardial infarction and PICSO during primary
revascularization with thrombolysis (risk reduction for event free
survival and reinfarction 60 months after the acute event (p<.0001).
Recently developed new technology was tested in an ongoing first in man
study performed in heart failure patients undergoing CRT implantation.
Stable hemodynamics and no safety concern coincided with an endorsement of
our hypothesis that PICSO activates regenerative pulses in heart failure
patients. Initial data on sequential pro BNP measurements as well as
quality of life data correspond with favorable patient survival up to 2
years. CONCLUSIONS: First in man experience emphasizes our hypothesis that
activation of pluripotent coronary venous endothelium is the common
denominator of the PICSO concept. New technology endorses future pivotal
clinical trials to underscore the clinical potential of PICSO as
adjunctive therapy in primary revascularization procedures and in the
quest to regenerate the failing heart.
<11>
Accession Number
70418450
Authors
Pavione M. Carmona F. Castro M. Carlotti A.
Institution
(Pavione, Carmona, Castro, Carlotti) Faculty of Medicine of Ribeirao
Preto, University of Sao Paulo, Brazil
Title
Assessment of remote ischemic preconditioning performed on the day before
open heart surgery in children undergoing cardiopulmonary bypass (the
second window effect).
Source
Pediatric Critical Care Medicine. Conference: 6th World Congress on
Pediatric Critical Care: One World Sharing Knowledge Sydney, NSW
Australia. Conference Start: 20110313 Conference End: 20110317.
Conference Publication: (var.pagings). 12 (3 SUPPL. 1) (pp A21), 2011.
Date of Publication: May 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: To evaluate postoperative inflammatory response, myocardial
dysfunction, morbidity and mortality in children undergoing remote
ischemic preconditioning (IPCr) on the day before heart surgery with
cardiopulmonary bypass (CPB), compared with a control group. Methods: This
was a randomized controlled trial. Children randomly assigned to IPCr were
submitted to four periods of five minutes of lower limb ischemia by a
blood pressure cuff intercalated with five minutes of reperfusion. Blood
samples were collected 4, 12, 24 and 48 hours after CPB end to evaluate
nuclear factor kappa-B (NF-kappaB) activation in leukocytes by
quantification of mRNA of its inhibitory protein, I kappa B-alpha, by
real-time PCR, and measurement of plasma concentrations of interleukin
(IL)-8 and IL-10 by ELISA. Myocardial dysfunction was assessed by
N-terminal pro-B type natriuretic peptide (NT-proBNP) and cardiac troponin
I (cTnI) plasma concentrations, measured by chemiluminescence, along with
clinical parameters of low cardiac output syndrome and need for vasoactive
drugs. Results: Twenty-two patients (aged 1-21 months) were studied: 12
allocated to the IPCr group and 10 to the control group. IPCr group had
lower values of NT-pro BNP at 12 and 24 hours after CPB end. Values of
cTnI were higher in IPCr group, but not significantly. IL-8 and IL-10
concentrations and I kappa B-alpha gene expression were similar in both
groups. Postoperative morbidity was similar in both groups; there were no
deaths in either group. Conclusion: Children undergoing IPCr on the day
before surgery had lower levels of NT-pro BNP postoperatively, which
indicates less myocardial dysfunction following CPB.
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