Exercise training after coronary angioplasty improves cardiorespiratory function

Aim. The aim of this prospective randomized study was to evaluate the impact of long-term aerobic exercise training on respiratory function, left ventricular systolic function and remodeling in patients with coronary heart disease and ischemic heart failure after successful angioplasty. Design. Patients (n=185) have undergone Doppler echocardiography and ergospirometry. Ninety-five patients practiced 6 month-term aerobic exercise training, less by 10% to their anaerobic threshold. Ninety patients were studied as controls. They were given only drug treatment without training. Measurements were repeated after 6 and 12 months. Results. Training group patients after 6 months showed significant (p<0.05) improvement in exercise capacity, oxygen consumption and ventilating equivalents. The Doppler echocardiographic findings revealed significant (p<0.05) improvement in ejection fraction, left ventricular and atria morphometric data. Improved ergospirometric and echocardiographic data were established after 12 months, too. Conclusions. Long-term aerobic exercise training is an effective and workable measure improving respiratory efficiency, left ventricular systolic function, attenuating negative remodeling and stopping further progression in patients with coronary heart disease and chronic heart failure after successful angioplasty.     

Ischemic mitral valve repair: predictive significance of restrictive left ventricular diastolic filling

AIM: The aim of the present study was to evaluate the impact of left ventricular (LV) diastolic filling impairment on postoperative results in patients with low LV ejection fraction (EF) undergoing combined coronary artery bypass grafting (CABG) and mitral valve (MV) repair. METHODS AND RESULTS: Study population consisted of 53 patients with ischemic MV incompetence and LV systolic dysfunction (mean EF-26.1 +/- 6%), who underwent CABG with MV repair. Patients were divided into three groups according to the LV diastolic filling pattern. Study protocol included evaluation of perioperative mortality (30 days inhospital mortality), NYHA functional class, and two-dimensional Doppler echocardiographic examination preoperatively, 10-14 days, and 12 months after surgery. The highest perioperative mortality rate (33.3%), unimproved functional status (in 78.5% of the patients, NYHA functional class remained unchanged late after surgery), and hemodynamic deterioration (LV dilatation, progression of mitral regurgitation (MR) was observed in the restriction group). Though early after surgery, MR reduction was significant in this group, at even one year after surgery 85.7% of patients presented with >grade 1 of MR (P < 0.05). Logistic regression analysis showed that restrictive LV diastolic filling is an important independent preoperative marker (P = 0.035) of progression of MR late after MV repair. CONCLUSION: In patients with severe LV dysfunction undergoing combined CABG and MV repair, restrictive LV diastolic filling pattern is an important preoperative marker of high perioperative mortality rate, further negative remodeling of LV, and progression of mitral regurgitation late after MV repair.     

Response of the charophyte Nitellopsis obtusa to heavy metals at the cellular,cell membrane,and enzyme levels

The responses of the freshwater macroalga Nitellopsis obtusa to heavy metal (HM) salts of Hg, Cd, Co, Cu, Cr, and Ni were assessed at different levels: whole-cell mortality (96-h LC(50)), in vivo cell membrane (45-min depolarization of resting potential, EC(50)), and enzyme in plasma membrane preparations (K+, Mg2+-specific H+-ATPase inhibition, IC(50)). To measure ATPase activity, a novel procedure for isolation of plasma membrane-enriched vesicles from charophyte cells was developed. The short-term ATPase inhibition assay (IC(50) from 6.0 x 10(-7) to 4.6 x 10(-4) M) was slightly more sensitive than the cell mortality test (LC(50) from 1.1 x 10(-6) to 2.6 x 10(-3) M), and the electrophysiological test with the end point of 45-min depolarization of resting potential was characterized by less sensitivity for HMs (EC(50) from 1.1 x 10(-4) to 2.2 x 10(-2) M). The variability of IC(50) values assessed for HMs in the ATPase assays was close to that of LC(50) values in the mortality tests (CVs from 33.5 to 83.5 and from 12.4% to 57.7%, respectively), whereas the EC(50) values in the electrophysiological tests were characterized by CVs generally below 30%. All three end points identified two separate HM groups according to their toxicity to N. obtusa: Co, Ni, and Cr comprised a group of less toxic metals, whereas Hg, Cu, and Cd comprised a group of more toxic metals. However, the adverse effects within each group were discriminated differently. For example, the maximum difference between the highest and lowest LC(50) for the group of less toxic metals in the long-term mortality test was approximately 60% of the response range, whereas the corresponding difference in IC(50) values in the ATPase assay was 30%. In contrast, the LC(50) values of the more toxic metals occupied only 10% of the response range, whereas the IC(50) values were spread over 70%. Further investigation should be done of the underlying mechanism or mechanisms responsible for the observed differences in the dynamic range of a particular end point of the groups of toxicants of varying strength.     

The production of reactive oxygen species in peripheral blood neutrophils is modulated by airway mucous

Neutrophils are a major source of reactive oxygen species (ROS). The role of airway mucous on ROS production is unknown. The aim of our study was to investigate the direct influence of bronchoalveolar lavage fluid (BALF) and induced sputum (IS) alone or in combination with chemical/biological stimulus on ROS production in peripheral blood neutrophils during chronic obstructive pulmonary disease (COPD). Neutrophils were isolated from peripheral blood of 47 patients with moderate COPD and 14 healthy individuals (HI). BALF/RPMI (1:1) or IS/RPMI (1:1) from COPD patients were used to stimulate neutrophils alone or in combination with phorbolmyristate- acetate (PMA) (0.1–30 nM) or Staphylococcus aureus bacteria (0.7–500 bact/neutrophil). Relative generation of ROS was measured flow cytometrically. BALF/RPMI and in combination with relatively low PMA or all bacteria concentrations stimulated ROS; while, combination with relatively high PMA concentrations suppressed ROS in of COPD patients and HI. IS/RPMI and its combination with PMA inhibited ROS generation in both groups; whereas, IS stimulated or had a tendency to stimulate ROS production with relatively high bacteria concentrations. In conclusion, BALF and IS directly or in combination with chemical/biological factors modulated ROS production. This effect was stronger in neutrophils from COPD patients and depended on chemical/biological stimulus intensity.     

beta3-adrenergic receptor activation increases human atrial tissue contractility and stimulates the L-type Ca2+ current

beta3-adrenergic receptor (beta3-AR) activation produces a negative inotropic effect in human ventricles. Here we explored the role of beta3-AR in the human atrium. Unexpectedly, beta3-AR activation increased human atrial tissue contractility and stimulated the L-type Ca2+ channel current (I Ca,L) in isolated human atrial myocytes (HAMs). Right atrial tissue specimens were obtained from 57 patients undergoing heart surgery for congenital defects, coronary artery diseases, valve replacement, or heart transplantation. The I(Ca,L) and isometric contraction were recorded using a whole-cell patch-clamp technique and a mechanoelectrical force transducer. Two selective beta3-AR agonists, SR58611 and BRL37344, and a beta3-AR partial agonist, CGP12177, stimulated I(Ca,L) in HAMs with nanomolar potency and a 60%-90% efficacy compared with isoprenaline. The beta3-AR agonists also increased contractility but with a much lower efficacy (approximately 10%) than isoprenaline. The beta3-AR antagonist L-748,337, beta1-/beta2-AR antagonist nadolol, and beta1-/beta2-/beta3-AR antagonist bupranolol were used to confirm the involvement of beta3-ARs (and not beta1-/beta2-ARs) in these effects. The beta3-AR effects involved the cAMP/PKA pathway, since the PKA inhibitor H89 blocked I(Ca,L) stimulation and the phosphodiesterase inhibitor 3-isobutyl-1-methylxanthine (IBMX) strongly increased the positive inotropic effect. Therefore, unlike in ventricular tissue, beta3-ARs are positively coupled to L-type Ca2+ channels and contractility in human atrial tissues through a cAMP-dependent pathway.     

A double-orifice tricuspid valve associated with a divided right atrium

Right atrioventricular valve duplication is a rare congenital anomaly with only isolated cases of a double-orifice tricuspid valve having been described. This article presents a case of the surgical repair of a double-orifice tricuspid valve associated with a divided right atrium, a ventricular septal defect, and Wolff-Parkinson-White syndrome.     

Influence of early re-infusion of autologous shed mediastinal blood on clinical outcome after cardiac surgery.

Various strategies have been proposed to decrease allogeneic blood transfusion requirements after cardiac surgery. The aim of the study was to evaluate the efficacy of collected and re-infused autologous shed mediastinal blood on a patient's postoperative course. Ninety patients who underwent heart surgery with cardiopulmonary bypass (CPB) were studied. The patients were divided into two groups: Group 1 (n=41) received the centrifuged autologous shed mediastinal blood collected from the cardiotomy reservoir 4 hours after surgery; in Group 2 (n=49) all shed mediastinal blood was discarded (control group). Haemoglobin (Hb), haematocrit (Hct), C-reactive protein values, and leucocyte count were compared before surgery, at 4 h and 20 h after surgery, and on the fifth postoperative day. We have measured serum procalcitonin (PCT) concentration at 4 h and 20 h after CPB. We assessed drained blood loss within 20 postoperative hours. Leucocyte count, Hb, Hct values, C-reactive protein, and procalcitonin concentration did not differ between the groups before and at 4 h after surgery. Hb, Hct level, and leucocyte count were similar at 20 hours and on the fifth day after surgery. At 20 hours after surgery, an increase of serum PCT concentration (>0.5-2 ng/mL) was more frequent in Group 2 (58.3% vs. 33.3%; p = 0.03). On the fifth postoperative day, C-reactive protein concentration was lower in Group 1 (71.74 +/- 15.23; p <0.01) compared to Group 2 (93.53 +/- 20.3). Postoperative blood loss did not differ between the groups. Requirement for allogeneic blood transfusion was significantly lower in Group 1 (14.6% vs. 38.8%; p < 0.02). Patients in Group 1 developed less infective complications compared with Group 2 (2.4% and 16.3%, respectively; p < 0.05). The length of postoperative in-hospital stay was shorter in Group 1 compared with Group 2 (9.32 +/- 2.55 and 16.45 +/- 6.5, respectively; p < 0.05). We conclude that postoperative re-infusion of autologous red blood cells processed from shed mediastinal blood did not increase bleeding tendency and systemic inflammatory response and was effective in reducing the requirement for allogeneic transfusion, the rate of infective complications and the length of postoperative in-hospital stay.     

The influence of mean arterial blood pressure during cardiopulmonary bypass on postoperative renal dysfunction in elderly patients

The aim of the study was to find out if there is an optimal mean arterial blood pressure (MABP) during cardiopulmonary bypass (CPB) for renal function in elderly patients during the early postoperative period. We analysed the data of 122 patients >70 years of age with normal preoperative renal function who had been subjected to coronary artery bypass grafting (CABG) procedures on CPB. Patients were divided into 3 groups, according to MABP during CPB: group MP (n=50) included patients whose MABP was maintained between 60-70 mmHg; group LP (n=36), the MABP was <60 mmHg; and group HP (n=36) where the MABP was >70 mmHg. The patients' clinical data were evaluated during the first three postoperative days. The rate of renal impairment (urine output <50ml/h) in the early postoperative period after cardiac surgery did not differ among the groups. Oliguria developed in 3 patients (6%) of the MP group, in 2 patients (5.6%) in the LP group and in 6 patients (16.7%) in the HP group (χ(2)=3.6, df=2, p=0.161). Evaluation of MABP on renal excretion showed that there was no difference in urine output among the groups. Serum creatinine levels at the end of the first postoperative day in groups MP, LP and HP were 102.7±20.1, 116.4±58.6 and 113.2±39.8 μmol/L, respectively (F=0.5, df=2, p=0.640). There were no significant differences among the groups at the end of the second and the third day either. Volume balance at the end of surgery and during the early postoperative period was similar in all groups. The need for diuretics did not differ among the groups. The length of postoperative hospital stay was not significantly different among the groups. Our study did not reveal any relationship between a MABP of 48-80 and postoperative renal dysfunction in elderly patients after CABG surgery.