Angiology current issue

Effects of Policosanol (10 mg/d) Versus Aspirin (100 mg/d) in Patients With Intermittent Claudication: A 10-Week, Randomized, Comparative Study

2008-06-10

Antiplatelet therapy, including aspirin, is recommended to lower the vascular risk in patients with intermittent claudication. Policosanol has increased walking distances in these patients, probably because of its antiplatelet effects, but the effect of shorter treatment has not been studied. This double-blind study compared the effects of policosanol 10 mg/d and aspirin 100 mg/d for 10 weeks on walking distances in claudicants. Thirty-nine patients were randomized to policosanol or aspirin. Walking distances on a treadmill were assessed before and after treatment. Policosanol significantly increased the initial and absolute claudication distances, while aspirin changed neither variable. Policosanol, not aspirin, significantly lowered serum low-density lipoprotein-cholesterol and total cholesterol while raising high-density lipoprotein-cholesterol. In conclusion, treatments of policosanol, not aspirin, for 10 weeks significantly increased walking distances, but modestly, in contrast with previous results. Therefore, the duration of treatments at the doses tested was too short for meaningful effects on the treadmill test.

Does Gender Influence the Patency of Infrainguinal Bypass Grafts?

Alpagut, U., Ugurlucan, M., Banach, M., Mikhailidis, D. P., Dayioglu, E. — 2008-06-10

Infrainguinal revascularization is an effective method of treatment for femoropopliteal/tibial occlusive diseases. However, these bypass grafts are prone to stenosis. In this retrospective study, the authors investigate the association of gender with patency of infrainguinal bypass grafts. The outcomes for consecutive 375 male and 200 female patients who underwent infrainguinal bypass surgery for arterial occlusive disease are compared, and associations with characteristics of the patients, surgical procedure, and graft stenosis are determined. It is found that several demographic, biochemical, and etiological factors could influence the patency of bypass procedures in different genders. However, infrainguinal arterial reconstruction procedures performed in women have a worse outcome when compared with that in men.

Bilateral Transit Time Assessment of Upper and Lower Limbs as a Surrogate Ankle Brachial Index Marker

Foo, J. Y. A. — 2008-06-10

Ankle brachial index is useful in monitoring the pathogenesis of peripheral arterial occlusive diseases. Sphygmomanometer is the standard instrument widely used but frequent prolonged monitoring can be less comfortable for patients. Pulse transit time is known to be inversely correlated with blood pressure and a ratio-based pulse transit time measurement has been proposed as a surrogate ankle brachial index marker. In this study, 17 normotensive adults (9 men; aged 25.4 ± 3.9 years) were recruited. Two postural change test activities were performed to induce changes in the stiffness of the arterial wall of the moved periphery. Results showed that only readings from the limbs that adopted a new posture registered significant blood pressure and pulse transit time changes (P < .05). Furthermore, there was significant correlation between the ankle brachial index and pulse transit time ratio measure for both test activities (R² ≥ 0.704). The findings herein suggest that pulse transit time ratio is a surrogate and accommodating ankle brachial index marker.

Age and Blood Pressure Levels Modify the Functional Properties of Central but Not Peripheral Arteries

2008-06-10

The effect of age and blood pressure on the carotid and the radial artery distensibilities was investigated. Patients referred to the outpatient clinic of the Department of Internal Medicine and Geriatric Medicine were asked to participate in the study. The carotid and radial artery distensibility coefficients were measured. Linear regression analyses were performed to investigate the associations between determinants and arterial distensibility. The mean age of the participants was 72.3 years, and 41.5% were men. Carotid distensibility decreased with age in adjusted models (β = –0.317; 95% confidence interval [CI], –0.241, –0.055), whereas the radial distensibility did not decrease. Levels of systolic blood pressure and mean arterial pressure were associated with decreasing levels of carotid distensibility, whereas the diastolic blood pressure and pulse pressure were not associated (β = –0.571; 95% CI, –0.404, –0.007; β = –0.410; 95% CI, –0.308, –0.101, respectively). In conclusion, age and blood pressure levels are associated with the distensibility of the central arteries but not with that of the peripheral arteries.

Doppler Ultrasound Compared With Strain Gauge for Measurement of Systolic Ankle Blood Pressure

Joensen, J.B., Juul, S., Abrahamsen, J., Henneberg, E.W., Lindholt, J. S. — 2008-06-10

This study assesses measurement variation in the measurement of ankle systolic blood pressure (ABP) when measured with Doppler ultrasound and with the strain gauge method. Ninety-seven patients were included. ABP was measured with Doppler ultrasound and with the strain gauge method. The methods were compared graphically by scatterplots and analyzed by paired t test, analysis of variance, and Pitman's paired variance ratio test. ABP was measured by strain gauge in all extremities, whereas no Doppler signal was obtainable in 7 limbs (4%). There was no systematic difference in measurements between the means of the two measurements. However, a substantial difference of more than 25 mm Hg was found in 15% of limbs and more than 20 mm Hg in 20%. In the majority of patients, measurements of ABP by Doppler ultrasound and the strain gauge method give similar results, but for a minority the discrepancy is substantial.

Acute Posttraumatic Ischemia of the Limbs: Algodystrophy or Related Syndrome? A Prospective Study on a Series of 25 Patients

Pistorius, M.-A., Connault, J., Kalassy, C., Goueffic, Y., Planchon, B. — 2008-06-10

The aim of this study was to present clinical and paraclinical features of a rarely studied vascular syndrome that usually occurs after a minor traumatic injury. The prospective study of 25 patients identified a group of young subjects, mainly women, generally with history of vascular hyperactivity to cold, showing disseminated pain in a limb always combined with vasospasm, consecutive to a minor traumatic injury in general, and simulating acute ischemia of a limb. The patients' arterial and microcirculatory flows were restored after warming, which proved that they were suffering from intense, reversible but pathological vasospasm, because of its duration, diffusion, intensity, and disproportion as to the triggering event. The symptoms may recur, but they respond to physiotherapy. Patients' follow-up showed that microcirculatory function remains abnormal sometime after the initial episode with, in particular, an exacerbation of the venoarteriolar reflex.

Assessment of Left Ventricular Functions in Patients With Isolated Coronary Artery Ectasia by Conventional and Tissue Doppler Imaging

2008-06-10

The authors sought to determine left ventricular functions by conventional and tissue Doppler imaging in patients with isolated coronary artery ectasia and controls. Peak early (E) and late (A) mitral inflow velocity, E/A ratio, E deceleration time, and isovolumetric relaxation time were obtained. Peak systolic velocity (Sm), diastolic early (Em), and late (Am) velocities were measured by tissue Doppler imaging. Interventricular septum velocities, including peak systolic (Ss), diastolic early (Es), and late (As) velocities, were recorded. Peak early (E) velocity, E/A ratio, and E deceleration time were different in both groups. Isovolumetric relaxation time was prolonged in patients with coronary artery ectasia than controls. Em and Em/Am ratio were lower in patients with coronary artery ectasia than controls. Diastolic early and Es/As velocities were lower in patients with coronary artery ectasia compared with controls. The authors showed that mitral inflow-lateral annulus and interventricular septum velocities were lower in patients with coronary artery ectasia than controls indicating left ventricular diastolic dysfunction.

Effect of Acute Cigarette Smoking on Left and Right Ventricle Filling Parameters: A Conventional and Tissue Doppler Echocardiographic Study in Healthy Participants

2008-06-10

Acute effects of smoking on left and right ventricular function is determined by conventional and tissue Doppler imaging methods in this study. Pulsed-wave Doppler indices of the left and right ventricle diastolic function, including mitral and tricuspid inflow peak early and late velocity and their ratio were obtained from 20 healthy subjects by conventional Doppler and tissue Doppler imaging. Echocardiographic indices of left and right ventricles, including isovolumetric relaxation time, deceleration time, isovolumetric contraction time, ejection time, and myocardial performance index of right ventricle were measured before and 30 minutes after smoking a cigarette. Mitral and tricuspid inflow parameters and right ventricular myocardial performance index significantly altered after smoking a cigarette. Among the tissue Doppler imaging parameters, mitral and tricuspid lateral annulus diastolic, but not systolic, velocities altered after smoking a cigarette. Acute cigarette smoking alters left and right ventricular diastolic functions in healthy nonsmokers.

Diverse Effects of Oxygen Inhalation on the Regional Myocardial Functions Related to the Degree of Coronary Artery Stenosis

Arat, N., Altay, H., Ilkay, E., Sabah, I. — 2008-06-10

In patients with stable coronary artery disease, the effect of oxygen (O₂) inhalation to regional myocardial functions and its relation to the degree of the coronary artery stenosis is still unclear. This article investigates the effect of O₂ therapy on regional myocardial functions in patients with coronary atherosclerosis according to the severity of stenosis. Myocardial segments were evaluated via tissue velocities, strain, strain rate, and tissue tracking. While O₂ inhalation improves late diastolic myocardial velocity and tissue tracking in normally perfused myocardial regions, a negative effect was observed on systolic and diastolic parameters of myocardial segments, which are perfused by insignificantly stenotic coronary arteries. Although nasal O₂ treatment has unfavorable effects on regional myocardial functions in patients with coronary artery disease, this effect remains subclinic with short-term inhalation. However, it is reasonable to pursue the effects of longer-term O₂ inhalation on myocardial function especially in patients with insignificant coronary stenosis.

N-terminal Prohormone Brain Natriuretic Peptide Plasma Levels in Heart Failure Are Affected Both Directly and Indirectly by Carvedilol

Kallistratos, M. S., Dritsas, A., Laoutaris, I. D., Cokkinos, D. V. — 2008-06-10

N-terminal prohormone brain natriuretic peptide (NT Pro BNP) is a sensitive marker of left ventricular function in patients with heart failure. The influence of carvedilol on NT Pro BNP plasma levels was analyzed in 21 heart failure patients. Blood samples were taken before administration and after 12 months of treatment with low-dose carvedilol. Peak oxygen consumption did not change after carvedilol treatment, left ventricular ejection fraction improved (P < .005) in 11 patients (52%), did not change in 9 (43%), and decreased in 1 (5%). In patients where left ventricular ejection fraction improved, NT Pro BNP tended to decrease; however, in patients without improvement, NT Pro BNP increased at follow-up. A correlation exists between magnitude of change in BNP and magnitude of improvement in ventricular function during carvedilol therapy. Patients without noticeable changes in left ventricular ejection fraction with a low to moderate carvedilol dosage show an increase in NT Pro BNP plasma levels.

Impact of Percutaneous Transluminal Septal Myocardial Ablation on Refractory Paroxysmal Atrial Fibrillation in Patients With Hypertrophic Obstructive Cardiomyopathy

Hosokawa, Y., Takano, H., Ohno, T., Takayama, M., Takano, T. — 2008-06-10

Atrial fibrillation is commonly observed in patients with hypertrophic obstructive cardiomyopathy. Episodes of paroxysmal atrial fibrillation are often torturous and limit the quality of life by causing congestive heart failure, transient hypotension, or bradycardia. Control of paroxysmal atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy is considered to be important for symptomatic improvement and prevention of the development to chronic atrial fibrillation. The authors report on 3 patients with hypertrophic obstructive cardiomyopathy who suffered from paroxysmal atrial fibrillation despite receiving medical treatment using antiarrhythmic agents. However, after undergoing percutaneous transluminal septal myocardial ablation, the incidence of episodes became significantly less frequent. Percutaneous transluminal septal myocardial ablation is normally performed for attenuating left ventricular obstruction by reducing the systolic anterior motion of the mitral leaflet. However, in these patients, this procedure was also effective in preventing supraventricular arrhythmia, probably by improving left ventricular diastolic dysfunction, smooth blood inflow into the left ventricular, and decreasing the pressure stress against the left atrial wall.

Risk Stratification of Apolipoprotein B, Apolipoprotein A1, and Apolipoprotein B/AI Ratio on the Prevalence of the Metabolic Syndrome: the ATTICA Study

2008-06-10

We investigated the association of apolipoproteins AI and B in relation to the prevalence of metabolic syndrome in a random sample of cardiovascular disease— free adults from the ATTICA study (1,514 men, aged 18-87 y; 1,528 women, aged 18-89 y). Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria. The prevalence of metabolic syndrome was 25% in men and 15% in women (P < .001). Using the area under the Receiver Operation Characteristic curve, apolipoprotein B/AI was the best diagnostic marker of metabolic syndrome, the optimal discriminating cut-off value of this ratio was 0.72 (sensitivity 74%, specificity 67%), and individuals with apolipoprotein B/AI ratio greater than 0.74 had 3.29 times higher odds of having metabolic syndrome (95% confidence interval: 2.56-4.21) after adjusting for potential confounders.

Endovascular Embolization of Intracranial Aneurysms

Guan, Y.-S., Wang, M.-Q. — 2008-06-10

Intracranial aneurysm (ICA) is a common condition but with a high mortality rate when rupture occurs. The treatment of ruptured or unruptured ICA, especially with an endovascular approach, has been evolving rapidly. The current generally accepted opinion suggests that endovascular embolization is an effective technique for preventing the recurrence of aneurysm rupture, but the rebleeding rate after endovascular embolization is found to be higher than that after surgical clipping. In addition, long-term follow-up data are required for the evaluation of the effectiveness of endovascular treatment in unruptured ICA. This review presents the current understanding of ICA, the selection of optimal treatment approaches, and in particular, the advances in endovascular embolization in the treatment of ICA, including embolic materials, therapeutic and assisting techniques, long-term effectiveness, and limitations.

Randomized, Double Blind, Placebo-Controlled Clinical Trial to Evaluate the Lymphagogue Effect and Clinical Efficacy of Calcium Dobesilate in Chronic Venous Disease

Flota-Cervera, F., Flota-Ruiz, C., Trevino, C., Berber, A. — 2008-06-10

The aims of the present study were to investigate the effect of calcium dobesilate on lymph flow and lymphovenous edema in patients with chronic venous disease. It was a randomized, placebo-controlled, double-blind clinical trial. Patients received 1 capsule of 500 mg calcium dobesilate every 8 hours (1.5 g/day) or placebo by 49 days. By the end of the treatment period, only the patients treated with calcium dobesilate had normalization of lymphogammagraphy (capture index and speed of lymph flow; 80 and 78%, respectively). Only patients treated with calcium dobesilate had statistically significant reduction in the perimeter of leg, calf, and ankle. Twenty-two out of 25 (88%) calcium dobesilate—treated patients presented clinical improvement versus 5 out of 24 (20.8%) in the placebo group. One patient on calcium dobesilate developed rash and one patient on placebo complained of vomiting. In the present study, calcium dobesilate normalized lymph physiology and improved symptoms in patients with chronic venous disease.

Endothelial Dysfunction in Chronic Obstructive Pulmonary Disease

2008-06-10

Background: Cardiovascular diseases are prevalent in people with chronic obstructive pulmonary disease (COPD). We hypothesized that endothelial dysfunction could be a marker of the proatherogen status in COPD. Methods and results: We measured endothelial dysfunction by flow-mediated dilation (FMD) and after sublingual administration of nitroglycerin (nitrate-mediated dilation: NMD) in 44 COPD patients and 48 controls. Compared with controls COPD patients had worse mean FMD (5.4% vs 8.2%, P < .001) and NMD (12.0% vs 13.9%, P = .007). FMD was inversely related to FEV1/VC ratio (r = –0.327, P = .030). The negative association between COPD and FMD was confirmed after correction for potential confounders in a multiple linear regression model (β = –0.019, P = .002). In the same model NMD (β = 0.396, P < .001) was positively associated with FMD. Conclusions: Endothelial-dependent and, to a lesser extent, endothelial-independent dilations are significantly impaired in COPD, and the impairment is proportional to the severity of bronchial obstruction.

Acute Pancreatitis Mimicking Acute Inferior Myocardial Infarction

2008-06-10

A 56-year-old man presented with acute pancreatitis and electrocardiographic abnormalities, suggesting acute inferior myocardial infarction. An emergent coronary angiogram showed normal coronary arteries. The clinical significance and therapeutic implications of this rare finding are discussed.

Successful Treatment of Primary Cardiac Angiosarcoma With Docetaxel and Radiotherapy

2008-06-10

A 49-year-old man was admitted for primary cardiac angiosarcoma with a cardiac tamponade. Transthoracic echocardiography and contrast-enhanced computed tomography scan demonstrated a large mass in the right atrium and thickening of the right ventricular wall. ¹⁸F-labeled deoxyglucose (FDG) positron emission tomography (PET) scan showed increased FDG uptake in the mediastinum and over the heart. The patient responded to combination therapy with docetaxel and radiotherapy and tolerated the treatment well, except for radiation esophagitis, which required a soft diet and resolved 1 month after treatment. This combination therapy resulted in a minimal response with slight regression in the tumor size, but FDG-PET initially showed an increase in FDG uptake by the tumor that was no longer seen after combination therapy. There is no evidence of progression or metastasis even at 12 months after diagnosis.

Percutaneous Thrombin Injection for Treatment of Iatrogenic Femoral Artery Pseudoaneurysms: A Case for Caution

Ohlow, M.-A., Secknus, M.-A., von Korn, H., Weiss, R., Lauer, B. — 2008-06-10

The case of a patient who developed a femoral artery pseudoaneurysm following cardiac catheterization is described. After 2 failed attempts of ultrasound-guided compression repair, the patient underwent percutaneous thrombin injection with, beside of complete closure of the pseudoaneurysm, a severe limb ischemia due to distal thrombin migration with consecutive clot formation finally resulting in thigh amputation of the affected leg. Indications, advantages, and disadvantages of various options for the treatment of iatrogenic femoral artery pseudoaneurysms (vascular surgery, ultrasound-guided compression, percutaneous thrombin injection, and other nonsurgical treatment modalities), as well as risk factors for distal migration of liquid thrombin after percutaneous injection, are discussed in this report.

Acute Myocardial Infarction in a Young Man Using Anabolic Steroids

Wysoczanski, M., Rachko, M., Bergmann, S. R. — 2008-06-10

Anabolic-androgenic steroids are used worldwide to help athletes gain muscle mass and strength. Their use and abuse is associated with numerous side effects, including acute myocardial infarction (MI). We report a case of MI in a young 31-year-old bodybuilder. Because of the serious cardiovascular complications of anabolic steroids, physicians should be aware of their abuse and consequences.

Intracoronary Administration of Isosorbide Dinitrate Induced Severely Slow Flow and Transient ST-Segment Elevation

Yamashita, K., Tasaki, H. — 2008-06-10

Nitroglycerin is one of the most widely used drugs in the treatment of angina. However, nitroglycerin fails to relieve angina in patients with syndrome X who have microvessel dysfunction. Microvessel function is impaired in several diseases. In this article, the authors report that despite normal coronary angiograms at control, intracoronary administration of isosorbide dinitrate induced severe coronary slow flow and transient ST-segment elevation with mild chest pain in a patient with congestive heart failure. The authors speculated that functional stenosis and a delay in the dilatation of microvessels less than 100 µm in diameter because of their dysfunction resulted in a severely slow flow after intracoronary administration of isosorbide dinitrate.

Spontaneous Coronary Artery Dissection Mimicking Acute Aortic Dissection

2008-06-10

Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome or sudden cardiac death, occurring predominantly in the female sex without cardiovascular risk factors. Although the etiology and pathogenesis remain uncertain, hypertension has not appeared to be one of the most important factors. This case report describes a patient with spontaneous coronary artery dissection in proximal Right coronary artery who presented the signs and symptoms of acute aortic dissection. The authors postulate that hypertension may have been an important factor for the pathogenesis of the spontaneous coronary artery dissection.

Erratum

2008-06-10