Reduction of the pyrexial response to acute myocardial infarction by beta-adrenoceptor blockade

We have studied the effect of beta-adrenoceptor blockade on the pyrexial response to acute myocardial infarction (AMI). Temperatures of 22 patients treated with timolol, 20 mg daily, in the acute phase of AMI were compared to temperatures of 22 patients not receiving timolol treatment. Fever response after AMI was significantly reduced in the timolol-treated patients, maximal and mean temperature in the febrile period being lower and the febrile period being shorter. Reduction of fever in AMI may be of importance as a higher body temperature increases the risk of developing heart failure and arrhythmias. The study lends support to the use of beta-adrenoceptor blockade in AMI. It also substantiates a possible role of beta-adrenergic receptors in the regulation of body temperature during fever.     

Should beta-blockers be given to patients with heart disease and peanut-induced anaphylaxis? A decision analysis

BACKGROUND: Beta-blocker therapy postmyocardial infarction is generally recommended because it reduces mortality. However, beta-blockers may increase anaphylaxis mortality in the growing population of patients with peanut-induced anaphylaxis. OBJECTIVE: We sought to assess the risks and benefits of beta-blocker therapy among patients with peanut allergy and heart disease. METHODS: We created a Markov model for patients with heart disease at risk for peanut-induced anaphylaxis to compare life expectancy with the following strategies: (1) beta-blocker and (2) no beta-blocker. Meta-analysis and a literature review were used to estimate model parameters. We performed sensitivity analysis to explore parameter uncertainty. RESULTS: For peanut-allergic patients who are postmyocardial infarction or who have congestive heart failure, the heart disease benefit of beta-blockers outweighs the increased likelihood of dying from anaphylaxis, increasing life expectancy by 9.4 and 17.4 months, respectively. Beta-blocker was preferred unless (1) the annual rate of moderate to severe anaphylaxis exceeded 6.0% for postmyocardial infarction and 15% for congestive heart failure patients; (2) beta-blocker therapy increased the incidence of moderate to severe anaphylaxis >2.5-fold for postmyocardial infarction and >5.8-fold for congestive heart failure patients; (3) anaphylaxis case fatality exceeded 6.5% postmyocardial infarction; or (4) beta-blocker therapy increased anaphylaxis case fatality >25-fold postmyocardial infarction. CONCLUSION: Our results suggest that for patients postmyocardial infarction or with congestive heart failure who are at risk for peanut-induced anaphylaxis, beta-blocker use should still improve survival. However, the epidemiology of anaphylaxis and effects of beta-blocker therapy on anaphylaxis incidence and mortality require further study.     

Association studies of gene polymorphisms in toll-like receptors 2 and 4 in Croatian patients with acute myocardial infarction

The aim of the study was to assess the frequency of SNP896A/G in the Toll-like receptor (TLR) 4 gene and SNP1350T/C in the TLR2 gene in patients with acute myocardial infarction (AMI) and to analyse the association of these SNPs with risk factors for atherosclerosis and clinical aspects of AMI in a sample of the Croatian population. We included 240 participants in the study: 120 AMI patients and 120 sex- and age-matched healthy blood donor controls. The SNP1350T/C variant in the TLR2 gene showed a lower frequency in the AMI patient group than in the control group (P = 0.033). The frequency of SNP896A/G variants in the TLR4 gene between the patients and the controls did not differ (P = 0.286). Significantly, fewer people had SNP1350T/C in the TLR2 gene (P = 0.003) among the participants with arterial hypertension than those without it. The frequency of SNP896A/G in TLR4 was the same in hypertensive patients compared with normotensive subjects (P = 0.088). SNP1350T/C in TLR2 was less frequent in the AMI patients and in those with hypertension. Thus, SNP1350T/C in TLR2 might play a protective role against AMI and arterial hypertension. The frequency of SNP896A/G in the TLR4 gene was not associated with AMI and arterial hypertension. Other risk factors for atherosclerosis and clinical aspects of myocardial infarction were not associated with the genotype distribution of the examined genes.     

Variability in plasma oestrogen concentrations in men with a myocardial infarction

Several studies have reported high levels of oestrogens--especially oestradiol--in plasma in men surviving an acute myocardial infarction (AMI). We have measured plasma levels of the two major oestrogens, oestrone and oestradiol, for three days during the acute AMI and at three months after discharge. Patients admitted to a coronary care unit with ischaemic heart disease without proof of an infarction and patients without evidence of heart disease served as controls. We found significantly higher oestrone levels during the acute infarction than at three months afterwards and also higher than in men without AMI. Men who died shortly after admission had grossly elevated plasma oestrone concentrations. As oestrone levels were correlated to excretion of catecholamines and cardiac enzyme levels in plasma and as circulating levels of oestrone are influenced by ACTH, the hyperoestronaemia may reflect stress-induced increased adrenocortical activity. Plasma oestradiol concentrations in men with AMI decreased significantly during the first three days after admission. In men given no medication oestradiol concentrations did not differ significantly from those in the control groups. Three months after the infarction, the median plasma oestradiol (but not oestrone) concentrations were significantly elevated, but not if only data from men given no medication were considered.     

The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group

BACKGROUND: Cardiovascular complications are the most important causes of perioperative morbidity and mortality among patients undergoing major vascular surgery. METHODS: We performed a randomized, multicenter trial to assess the effect of perioperative blockade of beta-adrenergic receptors on the incidence of death from cardiac causes and nonfatal myocardial infarction within 30 days after major vascular surgery in patients at high risk for these events. High-risk patients were identified by the presence of both clinical risk factors and positive results on dobutamine echocardiography. Eligible patients were randomly assigned to receive standard perioperative care or standard care plus perioperative beta-blockade with bisoprolol. RESULTS: A total of 1351 patients were screened, and 846 were found to have one or more cardiac risk factors. Of these 846 patients, 173 had positive results on dobutamine echocardiography. Fifty-nine patients were randomly assigned to receive bisoprolol, and 53 to receive standard care. Fifty-three patients were excluded from randomization because they were already taking a beta-blocker, and eight were excluded because they had extensive wall-motion abnormalities either at rest or during stress testing. Two patients in the bisoprolol group died of cardiac causes (3.4 percent), as compared with nine patients in the standard-care group (17 percent, P=0.02). Nonfatal myocardial infarction occurred in nine patients given standard care only (17 percent) and in none of those given standard care plus bisoprolol (P<0.001). Thus, the primary study end point of death from cardiac causes or nonfatal myocardial infarction occurred in 2 patients in the bisoprolol group (3.4 percent) and 18 patients in the standard-care group (34 percent, P<0.001). CONCLUSIONS: Bisoprolol reduces the perioperative incidence of death from cardiac causes and nonfatal myocardial infarction in high-risk patients who are undergoing major vascular surgery.     

Effect of severity of "risk region" on therapeutic intervention of myocardial infarction size.

Isosorbide dinitrate was tried in 27 patients of acute myocardial infarction (AMI) with the purpose of reduction of infarction size. Overall average effect was not significant. But, it was found that, the small and moderate "predicted infarction size" (PIS) group of patients, were benefitted by the drug therapy. Effectiveness in the therapeutic intervention on ischaemic injury bore an inverse relation with the degree of PIS or the "risk region". Varying "risk region" may be an important factor responsible for the apparent discrepancy between results of different workers regarding therapeutic intervention of infarction size.     

老老年急性心肌梗死患者介入治疗的疗效及近期安全性评价

目的评价老老年（≥80岁）急性心肌梗死（AMI）患者行急诊与择期经皮冠状动脉介入治疗术（PCI）的有效性和近期安全性。方法将120例老老年冠心病患者分为急性心肌梗死组（AMI组）和非心肌梗死组（对照组）,其中AMI组发病12h内行直接PCI的患者为AMI急诊组,其他AMI患者（AMI择期组）和对照组患者均行择期PCI,两组合称为非急诊组,对各组的临床资料及冠脉介入特点进行回顾性分析。结果 AMI急诊组PCI即刻成功率（72.2%）低于非急诊组（92.2%）,差异有统计学意义（P=0.036）。AMI急诊组并发症比非急诊组和AMI择期组高,差异有统计学意义（P〈0.001,P=0.039）,AMI组并发症及主要不良心脏事件发生率、院内死亡率均比对照组高（P〈0.05）。结论在老老年AMI患者中,急诊与择期PCI手术成功率均较高,虽然急诊PCI术发生并发症的风险较高,但两者在院内死亡率和主要不良心脏事件发生率方面差异无统计学意义。     

丹红注射液对脑梗死患者血浆可溶性Fas及Fas配体浓度的影响

目的：观察丹红注射液对脑梗死患者血浆可溶性Fas及Fas配体浓度的影响,探讨丹红注射液用于脑梗死治疗的抗凋亡作用。方法：80例脑梗死患者分为对照组和治疗组,每组40例。对照组接受常规治疗,治疗组接受常规治疗加用丹红注射液治疗。脑梗死患者静脉血在人院时,人院后第1、2、3、7和14d获得,ELISA测定血浆可溶性Fas及Fas配体浓度。结果：治疗前,治疗组美国国立卫生院神经功能缺损评分与对照组比较差异无统计学意义（P〉0．05）;治疗后,治疗组美国国立卫生院神经功能缺损评分较对照组显著下降（P〈0．05）。人院时,治疗组血浆可溶性Fas及Fas配体浓度与对照组比较差异无统计学意义（P〉0．05）,人院后第1、2、3、7和14d,治疗组血浆可溶性Fas及Fas配体浓度显著低于对照组（P〈0．05）。结论：丹红注射液可能通过抑制脑梗死后神经细胞凋亡,从而达到改善神经功能的目的。     

Sustained antihypertensive effect of captopril combined with diuretics and beta-adrenergic blocking drugs in patients with resistant hypertension

Ten patients with severe hypertension and unsatisfactory blood pressure control during combined therapy with beta-adrenergic blocking drugs, diuretics, and vasodilators were treated with gradually increasing doses of captopril. Vasodilators were discontinued 24 hours prior to captopril administration. Six patients had essential, two renal, and two renovascular hypertension. Mild renal impairment was observed in four patients. Captopril effectively decreased blood pressure for 3 hours in all patients after the first dose. The antihypertensive effect appeared to be triphasic and was sustained in all but one patient during 12 months of observation. Captopril doses of 25-75 mg t.i.d. were sufficient to achieve acceptable blood pressure control (RR less than or equal to 160/100 mmHg) when given in the above mentioned combination. Side-effects were few and tolerable and discontinuation of captopril was not required.     

Factor VIII activity among young Mexican patients with acute myocardial infarction

BACKGROUND: Atherothrombotic disease is the leading cause of death worldwide. Most casualties are due to acute myocardial infarction (AMI). Patients younger than 45 years account for 5-10% of AMI cases. These patients generally do not display typical atherothrombotic risk factors. METHODS: Our cross-sectional study included adult patients under 45; men and women with AMI were included. A control group of healthy individuals matched for age, sex, and blood group was included to determine the role of several atherothrombotic risk factors on AMI. One hundred and sixty patients were included, the control group was comprised by 77 males (m) and 83 females (f) RESULTS: Our results indicate that 25% of patients (23 m and 18 f) had increased FVIII compared with 8.8% of control subjects. Mean FVIII activity for patients and controls was 134 mg/dl (95%CI=114) vs. 118 mg/dl (95%CI=128-140), respectively (p=0.001). Prevalence of elevated FVIII was higher than the one found for hypertension or diabetes mellitus. HDL cholesterol was higher among patients than controls. Quantitative variables associated with AMI were high FVIII activity, blood monocyte count and HDL cholesterol. CONCLUSIONS: Classical atherothrombotic risk factors do not fully explain AMI events in the young. High levels of FVIII activity is a moderate but common risk factor in young people suffering AMI.     

Effects of beta-adrenergic and calcium antagonists on the development of anaphylactoid reactions from radiographic contrast media during cardiac angiography

Anaphylactoid reactions (ARs) occurring in patients receiving propranolol have been described as unusually severe and having a "sluggish" response to epinephrine. Although the mechanism of ARs to iodinated radiographic contrast media is not IgE mediated, because of widespread use of beta-adrenergic blocking agents, we undertook a prospective study to determine the incidence of AR to radiographic contrast media during cardiac angiography. Nine hundred fifty-two consecutive patients were divided into four groups according to concomitant chronic medications. Group I (447 patients) were receiving no beta-adrenergic blocking agents or calcium antagonists. Group II (216 patients) were receiving a beta-adrenergic blocking agent. Group III (147 patients) were receiving a calcium antagonist but not a beta-adrenergic blocking agent. Group IV (142 patients) were receiving both a calcium antagonist and a beta-adrenergic blocking agent. The reaction rates, respectively, in the four groups were 4.47%, 7.41%, 5.44%, and 4.93%. The rates of ARs were not associated with the use of concomitant medications in any of the groups (chi 2 = 2.531; p = 0.47). The probability of a type II error in comparison of groups I and II was 0.75 should the true incidence of reactions in patients receiving beta-adrenergic antagonists be 7.41%. No difference in the incidence of AR was observed between patients taking selective and nonselective beta-adrenergic blocking agents in group II. Specific ARs occurring in patients receiving beta-adrenergic blocking agents were usually mild and often without need for specific pharmacotherapy.     

抑郁对急性心肌梗死患者心率变异及预后的影响

研究发现 ,冠心病患者常合并焦虑、抑郁情绪障碍 ,抑郁被认为是冠心病的独立危险因素[1,2 ] 。心率变异性 (ｈｅａｒｔｒａｔｅｖａｒｉａｂｉｌｉｔｙ ,ＨＲＶ)是指窦性心率在一定时间内周期性改变的现象 ,是反映交感与副交感神经张力及其平衡的重要指标。ＨＲＶ减低是确定急性心肌梗死 (ａｃｕｔｅｍｙｏｃａｒｄｉａｌｉｎｆａｒｃｔｉｏｎ ,ＡＭＩ)患者危险分层 ,预测其预后的一个独立的敏感指标[3] 。因此 ,本研究旨在观察抑郁对ＡＭＩ患者ＨＲＶ及近期预后的影响。1　对象与方法1.1　对象选择 1999年 5月～ 2 0 0 1年 12月住院、未行…     

自体骨髓干细胞原位移植治疗急性心肌梗死的临床研究

目的:用粒细胞集落刺激因子(G-CSF)动员自体骨髓干细胞进入心肌梗死部位原位移植以修复梗死心肌组织,探讨其对急性心肌梗死患者心肌梗死面积及心功能的影响。方法:25例初次急性心肌梗死患者在入院后随机分为干细胞原位移植组(n=12)和对照组(n=13)。干细胞原位移植组于入院后在常规治疗基础上加用G-CSF动员自体骨髓干细胞进行心肌梗死原位移植;对照组按急性心肌梗死常规方法治疗。于入院第(1、28d)描记常规12导联心电图,采用Wagner的QRS波群记分法评价心功能,于入院(7、28d)行核素心肌灌注断层显像,测量心肌梗死面积。结果:G-CSF治疗4周,干细胞原位移植组QRS记分值明显降低,显著低于对照组(P＜0.05);心肌梗死面积由36.0%±8.3%下降至18.0%±5.8%,显著小于对照组(P＜0.05)。结论:用G-CSF动员自体骨髓干细胞来修复坏死心肌组织的"干细胞原位移植"疗法,能减小心肌梗死的范围,改善心功能。     

Effect of isosorbide dinitrate on enzymatically estimated infarction size and on clinical condition of the patients of acute myocardial infarction

With the aim of reducing myocardial infarction size, isosorbide dinitrate (ISDN) was tried in 27 patients of acute myocardial infarction (AMI). There was 11% reduction of infarction size, in the ISDN treated group, in comparison to that of non treated group, though the result was not statistically significant. But, many of the in-hospital complications were significantly less in the treated group. After a critical analysis of the result it was concluded that a statistically insignificant result, as regard reduction of infarction size in AMI, cannot always exclude the utility of a drug therapy in AMI.     

丹红注射液对脑梗死患者血浆抵抗素和瘦素浓度的影响

目的:观察丹红注射液对脑梗死患者血浆抵抗素和瘦素浓度的影响,探讨丹红注射液用于脑梗死治疗的机制.方法:80例脑梗死患者分为对照组和治疗组,每组40例.对照组接受常规治疗,治疗组接受常规治疗加用丹红注射液治疗.脑梗死患者静脉血在入院时、入院后第1、2、3、7和14d获得,ELISA测定血浆抵抗素和瘦素浓度.结果:治疗前,治疗组美国国立卫生院神经功能缺损评分与对照组比较差异无统计学意义(P>0.05);治疗后,治疗组美国国立卫生院神经功能缺损评分较对照组显著下降(P<0.05).入院时,治疗组血浆抵抗素和瘦素浓度与对照组比较差异无统计学意义(P>0.05),人院后第1、2、3、7和14d,治疗组血浆抵抗素和瘦素浓度显著低于对照组(P<0.05).结论:丹红注射液可能通过抑制脑梗死后炎性反应,从而达到改善神经功能的目的.     

急性心肌梗死病人血浆巨噬细胞移动抑制因子水平变化的研究

目的 :研究急性心肌梗死 (AMI)病人血浆巨噬细胞移动抑制因子 (MIF)水平变化的特征。方法 :征集完全符合诊断标准的AMI病人 37例 ,不稳定型心绞痛 (UA)病人 2 6例 ,稳定型心绞痛 (SA)病人 39例 ,接受经皮腔内冠状动脉成形术(PTCA)病人 2 6例 ,有非典型胸痛而冠状动脉造影正常的对照组 31例。这几组病人分别在发病第 1,2 ,3天抽取血样 ,用酶联免疫吸附试验 (ELISA)检测MIF水平 ,用贝克曼生化仪检测心肌酶的水平。结果 :在发病第 1～ 3天 ,AMI病组与SA组、UA组、PTCA组、对照组等比较 ,AMI病组血浆MIF水平明显高于其它病组 ,差异具有显著性 (P <0 0 0 1)。在发病第 1,2天 ,其MIF水平变化量的差异也具有显著性 (P <0 0 5 )。结论 :血浆MIF升高不仅可反映AMI病人病情的严重性 ,而且在预测AMI早期的潜在危险性方面具有重要作用     

血小板膜糖蛋白Ia基因807nt多态性与急性心肌梗死的关系研究

目的通过检测急性心肌梗死患者及对照人员的血小板膜糖蛋白（GP Ia）基因807nt多态性,探讨该多态性与急性心肌梗死发病的关系。方法血小板膜糖蛋白Ia基因807nt多态性分析：（1）碘化钾法提取人基因组DNA。（2）多聚酶链反应（PCR）扩增目的基因片段。（3）酶切产物经2%琼脂糖凝胶电泳分离后,紫外灯下检测酶切结果。（4）SPSS11.5软件分析数据。结果（1）急性心肌梗死组血小板膜糖蛋白Ia基因807nt处T等位基因频率显著高于对照组。（2）急性心肌梗死组血小板膜糖蛋白Ia基因807ntTT＋TC基因型频率显著高于对照组。（3）在血小板膜糖蛋白Ia基因807ntTT＋TC和CC基因型之间,高血压病和糠尿病的发病率无显著性差异。（4）在血小板膜糖蛋白Ia基因807nt TT＋TC和CC基因型之间,空腹血糖、血清甘油三脂浓度无显著性差异。（5）急性心肌梗死患者平均甘油三脂水平显著高于对照组。结论（1）血小板膜糖蛋白Ia基因807nt处T等位基因可能是急性心肌梗死发病的独立遗传性危险因素。（2）血小板膜糖蛋白Ia基因807nt多态性可能与高血压病、糖尿病的发病及糖代谢等无关。     

Plasma tissue plasminogen activator and plasminogen activator inhibitor-1 levels in acute myocardial infarction

The cause of the circadian variation in the incidence of acute myocardial infarction (AMI) has not been identified. Tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) have opposing effects on thrombi. Hence, the extent of the clot, the size of the infarct and outcome of patients could depend on t-PA and PAI-1 levels. In an effort to elucidate the pathophysiologic basis of circadian variation of AMI, we investigated the presence of a possible corresponding circadian variation in the levels of endogenous t-PA and PAI-1 in patients diagnosed to have AMI and the effects of hypertension, diabetes and site of the infarct on these levels. We estimated the levels of t-PA and PAI-1 in platelet-poor plasma of 42 patients with AMI on admission, using the enzyme-linked immunosorbant assay. Although not statistically significant, patients having an AMI in the morning hours had the highest t-PA:PAI-1 ratio. The normal circadian variation in PAI-1 levels was lost in patients with AMI, probably due to the disease process. Also, the t-PA levels in hypertensive patients were significantly lower than in nonhypertensives. PAI-1 levels were also significantly lower in patients with anteroseptal than in inferior and anterolateral AMI. This relationship between the fibrinolytic potential and the site of infarction needs further study. Furthermore, t-PA levels on admission were significantly lower in survivors and may have a predictive value in determining the outcome.     

The pro- and anti-inflammatory markers in patients with acute myocardial infarction and chronic stable angina

The aim of this study was to assess the plasma levels of VEGF and interleukin-10 in patients with acute myocardial infarction (AMI) and stable chronic angina (SA) and correlate the values with traditional CHD risk factors, left ventricular ejection fraction (LVEF) and established inflammatory marker hsCRP. Fifty patients with AMI and 30 with SA were enrolled. IL-10 levels in AMI patients were lower than in SA patients (9.81 +/- 5.0 versus 22.63 +/- 8.38 pg/ml, p < 0.00001). IL-10 levels were lower in AMI and SA patients with multiple CHD risk factors than in patients < or = 2 risk factors (SA: 19.48 +/- 2.94 versus 23.77 +/- 2.94 pg/ml; p < 0.005; AMI: 8.64 +/- 4.43 versus 11.85 +/- 4.09 pg/ml; p < 0.05) and patients with AMI and single-vessel than with multi-vessel disease (8.45 +/- 3.86 versus 10.72 +/- 3.95 pg/ml; p < 0.05). VEGF levels in AMI patients were higher than in SA patients (312.0 +/- 67.0 versus 221.0 + /- 50 pg/ml; p < 0.005). VEGF levels were higher in AMI patients with multi-vessel disease than in patients with single-vessel disease (348.74 +/- 45.23 versus 252.05 +/- 21.12 pg/ml; p < 0.005), with LVEF <40% and Killip class III-IV than in patients with LVEF >40% and Killip class I-II (338.8 +/- 51.59 versus 271.8 +/- 50.51 pg/ml; p < 0.005 and 340.71 +/- 52.94 versus 275.45 +/- 49.48 pg/ml; p < 0.05, respectively) and with chest pain > 6 h versus < 6 h (330.03 +/- 58.58 versus 292 +/- 57.53 pg/ml; p < 0.05). HsCRP concentrations in AMI patients were higher than in SA (1.24 +/- 0.47 versus 0.42 +/- 0.14; p < 0.0001). HsCRP was correlated with IL-10 (r = -0.413; p < 0.05) and VEGF (r = 0.319; p < 0.05). Acute myocardial infarction is associated with elevated VEGF levels and decreased concentration of IL-10. There is a significant correlation between levels of inflamatory markers and CHD risk factors and the function of the left ventricle on admission.     

Prophylactic furosemide treatment in acute myocardial infarction

Prophylactic diuretic therapy in acute myocardial infarction (AMI) was evaluated in 83 consecutive patients without severe left ventricular failure (LVF) on admission. A high dose group (HDG) received 120-160 mg and a low dose group (LDG) 20-40 mg furosemide daily for six weeks. Mortality and reinfarction rates did not differ between the groups. One HDG patient and five LDG patients developed severe LVF. Four HDG patients developed severe dehydration. Serum enzyme activities and electrolytes were similar in both groups. The increased diuresis in the HDG was accompanied by a 4% hemoconcentration, smaller radiological heart volumes, higher heart rates, a higher demand for nitroglycerin and higher ratings of thirst. Exercise tests yielded similar results in both groups. Later blood volumes and transthoracic electrical impedance were similar in both groups. It is concluded that liberal prophylactic furosemide treatment in AMI offers no major clinical advantage.