Mortality by Heart Failure and Ischemic Heart Disease in Brazil from 1996 to 2011

Background

Circulatory system diseases are the first cause of death in Brazil.

Objective

To analyze the evolution of mortality caused by heart failure, by ischemic heart diseases and by ill-defined causes, as well as their possible relations, in Brazil and in the geoeconomic regions of the country (North, Northeast, Center-West, South and Southeast), from 1996 to 2011.

Methods

Data were obtained from DATASUS and death declaration records with codes I20 and I24 for acute ischemic diseases, I25 for chronic ischemic diseases, and I50 for heart failure, and codes in chapter XIII for ill-defined causes, according to geoeconomic regions of Brazil, from 1996 to 2011.

Results

Mortality rates due to heart failure declined in Brazil and its regions, except for the North and the Northeast. Mortality rates due to acute ischemic heart diseases increased in the North and Northeast regions, especially from 2005 on; they remained stable in the Center-West region; and decreased in the South and in the Southeast. Mortality due to chronic ischemic heart diseases decreased in Brazil and in the Center-West, South and Southeast regions, and had little variation in the North and in the Northeast. The highest mortality rates due to ill-defined causes occurred in the Northeast until 2005.

Conclusions

Mortality due to heart failure is decreasing in Brazil and in all of its geoeconomic regions. The temporal evolution of mortality caused by ischemic heart diseases was similar to that of heart failure. The decreasing number of deaths due to ill-defined causes may represent the improvement in the quality of information about mortality in Brazil. The evolution of acute ischemic heart diseases ranged according to regions, being possibly confused with the differential evolution of ill-defined causes.     

Do clinical diagnoses correlate with pathological diagnoses in cardiac transplant patients? The importance of endomyocardial biopsy

BACKGROUND:

Heart transplantation remains the last treatment option for patients with end-stage cardiac disease. Such diseases include ischemic cardiomyopathy, nonischemic cardiomyopathy and other conditions such as arrhythmogenic right ventricular dysplasia, cardiac sarcoidosis and cardiac amyloidosis.

OBJECTIVE:

To review the changes that have occurred over time in the etiology of heart disease in patients requiring heart transplantation, and to compare the clinical and histological diagnoses of explanted hearts from patients with progressive cardiac disease.

METHODS:

The pathological findings of 296 surgically excised hearts over a 20-year period (January 1987 to July 2006) at one institution were examined. Patients were separated into groups based on year of heart transplantation. The tissue was examined to determine the underlying cardiac pathology leading to congestive heart failure. Patient records were reviewed for preoperative clinical diagnoses and other relevant data, including pretransplant endomyocardial biopsy (EMB) results, information regarding left ventricular assist devices and, finally, evidence of disease recurrence in the grafted heart.

RESULTS:

A shift in the underlying etiology was found in patients who underwent heart transplantation from 1992 to 1996, and 1997 to 2001. Between 1987 and 1997, the majority of transplant cases consisted of ischemic cardiomyopathies. From 1997 to 2001, the majority of patients had nonischemic cardiomyopathies, and this trend continued to 2006. A majority of patients with ischemic and hypertrophic cardiomyopathy were diagnosed correctly (96.5% and 82%, respectively) before transplantation. Most patients diagnosed post-transplant with lymphocytic (viral, 15%), hypersensitive/eosinophilic (25%) and giant cell (100%) myocarditis, arrhythmogenic right ventricle dysplasia (100%), cardiac sarcoidosis (83%) and iron overload toxicity-associated cardiomyopathy (100%) had been misdiagnosed in pre-transplantation investigations. Investigations before transplantation did not include an EMB. Of all 296 patients, 51 patients (17%) were misdiagnosed. Excluding the patients with ischemic cardiomyopathy, 46 of 152 patients (30%) were misdiagnosed before transplantation.

CONCLUSIONS:

Although cardiac transplantation is a viable treatment option for patients with a variety of cardiac diseases, accurate diagnosis of patients before transplantation remains a priority. Accurate diagnosis of particular diseases (sarcoidosis, myocarditis, iron toxicity-associated cardiomyopathy and others) allows for proper treatment before transplantation, which may slow down disease progression and improve patient outcomes. Furthermore, it is important to accurately diagnose patients with diseases such as sarcoidosis, amyloidosis and particular types of myocarditis because these can readily recur in the grafted heart. The risk for recurrence must be known to practitioners and, most importantly, to the patient. We strongly recommend the use of EMB if a nonischemic cardiomyopathy is suspected, because the results may alter the diagnosis and modify the treatment strategy.     

Mortality among subjects with chronic obstructive pulmonary disease or asthma at two respiratory disease clinics in Ontario

BACKGROUND:

Chronic obstructive pulmonary disease (COPD) and asthma are common; however, mortality rates among individuals with these diseases are not well studied in North America.

OBJECTIVE:

To investigate mortality rates and risk factors for premature death among subjects with COPD.

METHODS:

Subjects were identified from the lung function testing databases of two academic respiratory disease clinics in Hamilton and Toronto, Ontario. Mortality was ascertained by linkage to the Ontario mortality registry between 1992 and 2002, inclusive. Standardized mortality ratios were computed. Poisson regression of standardized mortality ratios and proportional hazards regression were performed to examine the multivariate effect of risk factors on the standardized mortality ratios and mortality hazards.

RESULTS:

Compared with the Ontario population, all-cause mortality was approximately doubled among subjects with COPD, but was lower than expected among subjects with asthma. The risk of mortality in patients with COPD was related to cigarette smoking, to the presence of comorbid conditons of ischemic heart disease and diabetes, and to Global initiative for chronic Obstructive Lung Disease severity scores. Individuals living closer to traffic sources showed an elevated risk of death compared with those who lived further away from traffic sources.

CONCLUSIONS:

Mortality rates among subjects diagnosed with COPD were substantially elevated. There were several deaths attributed to asthma among subjects in the present study; however, overall, patients with asthma demonstrated lower mortality rates than the general population. Subjects with COPD need to be managed with attention devoted to both their respiratory disorders and related comorbidities.     

Exercise above the ischemic threshold and serum markers of myocardial injury

BACKGROUND:

Current guidelines for exercise training in coronary patients state that in the presence of exercise-induced ischemia, the heart rate during exercise should be at least 10 beats/min below the heart rate associated with an ST segment depression of 1 mm or greater. For patients with a relatively low ischemic threshold, this recommendation does not allow for a sufficient training stimulus.

OBJECTIVE:

To document the effects of a single session of exercise above the ischemic threshold on biochemical markers of myocardial injury in stable coronary patients with exercise-induced ischemia. Because creatine kinase (CK) and its MB isoenzyme (CK-MB) can both increase after exercise because of skeletal muscle injury, troponin T was also measured.

METHODS:

Twenty-one patients with documented coronary artery disease underwent two 20 min exercise sessions. The intensity of the first exercise training session was fixed at a heart rate below the ischemic threshold (ie, approximately 10 beats/min lower than the heart rate associated with the appearance of an ST segment depression of 1 mm or greater). The intensity of the second exercise session was fixed at a heart rate above the ischemic threshold.

RESULTS:

Blood test measurements at baseline, 6 h after and 24 h after the exercise sessions did not show any increase in total CK, CK-MB or troponin. The value of all measurements remained well below the lower limits associated with myocardial damage.

CONCLUSION:

A 20 min period of exercise above the ischemic threshold did not result in myocardial necrosis.     

Prevalence of nonalcoholic fatty liver disease (NAFLD) in patients of cardiovascular diseases and its association with hs-CRP and TNF-α

Background

There is increasing recognition of association of nonalcoholic fatty liver disease (NAFLD) with cardiovascular disease (CVD). Metabolic syndrome is common in both NAFLD and cardiovascular diseases. Our study is designed to investigate the association of NAFLD with cardiovascular disease.

Methods

It''s a cross-sectional study which included 104 patients of coronary artery disease and hypertensive heart disease. Those patients having secondary causes of steatosis were excluded. Complete cardiovascular evaluation which included assessment of metabolic syndrome, routine biochemistries, viral markers, Ultrasonography (USG) abdomen, hs-CRP and TNF-α levels were obtained for all patients.

Results

Of all patients with cardiovascular disease, 19.2% (20/104) had essential hypertension with hypertensive heart disease the remaining 80.8% (84/104) patients had ischemic heart disease (IHD). On USG 69.2% (72/104) had NAFLD, these 50% (36/72) had grade 1 NAFLD and the rest grade 2 NAFLD. The hs-CRP levels and TNF-α were significantly higher in patients with NAFLD (p-value <0.001) and within patients with NAFLD the levels were higher in patients with grade 2 NAFLD. Also, binary logistic regression showed that high body-mass index (BMI), raised serum triglyceride levels, increased waist circumference and hypertension were significantly associated with the presence of NAFLD.

Conclusion

Our data indicates that NALD is highly prevalent in patients of cardiovascular disease (69.2%) and is significantly associated with metabolic syndrome and its individual components. The levels of hs-CRP and TNF-α were significantly higher in patients with NAFLD and showed an increasing trend with the severity of fatty liver.     

Red blood cell distribution width and cardiovascular diseases

Background

The red blood cell distribution width (RDW) is a rather simple measure of red blood cell (RBC) size heterogeneity (i.e., anisocytosis), which is easily calculated by dividing the standard deviation (SD) of erythrocyte volumes for the mean corpuscular volume (MCV). Emerging evidence suggests that, besides RBC abnormalities, many human disorders may be frequently associated with a high degree of anisocytosis.

Methods

In this narrative review, we analyzed the current scientific literature about the putative role and the potential epidemiologic association between RDW and cardiovascular diseases. The findings of the most representative epidemiological studies were summarized and discussed.

Results

Overall, considerable and convincing evidence has been brought that an increased RDW value is associated with acute coronary syndrome (ACS) [including acute myocardial infarction (AMI)], ischemic cerebrovascular disease (including stroke), peripheral artery disease (PAD), as well as with atrial fibrillation (AF), heart failure (HF) and hypertension. Higher anisocytosis also significantly and independently predicts adverse outcomes in patients with these conditions.

Conclusions

Although the role of anisocytosis in the pathogenesis of cardiovascular diseases remains uncertain, the considerable evidence available so far suggests that the clinical use of RDW may be broadened beyond the conventional boundaries of erythrocyte disorders, in particular for assisting the diagnosis and prognostication of patients with ACS, ischemic cerebrovascular disease, PAD, HF and AF.     

The Saudi Project for Assessment of Coronary Events (SPACE) registry: Design and results of a phase I pilot study

OBJECTIVE:

The delay between the availability of clinical evidence and its application to the care of patients with acute coronary syndrome (ACS) in the Kingdom of Saudi Arabia remains undefined. The Saudi Project for Assessment of Coronary Events (SPACE) registry provides a comprehensive view of the current diagnostic and treatment strategies for patients with ACS; thus, the registry may be used to identify opportunities to improve the care of these patients.

METHODS:

Eight hospitals in different regions of Saudi Arabia were involved in the pilot phase of the registry, from December 2005 to July 2006. The study patients included individuals with ST segment elevation myocardial infarction (STEMI), non-STEMI and unstable angina.

RESULTS:

A total of 435 patients (77% men and 80% Saudis) with a mean age of 57.1 years were enrolled. Medical history included previously diagnosed ischemic heart disease (32%), percutaneous coronary intervention (12%), diabetes mellitus (53%), hypertension (48%), current smoking (39%), hyperlipidemia (31%) and family history of premature coronary artery disease (11%). The median door-to-needle time for fibrinolytic therapy received by patients with STEMIs was 90 min. Inhospital medications included acetylsalicylic acid (98%), clopidogrel (73%), angiotensin-converting enzyme inhibitors (74%), beta-blockers (73%), statins (88%), unfractionated heparin (80%), low-molecular weight heparin (22%) and glycoprotein IIb/IIIa inhibitors (9%). The inhospital mortality rate was 5%.

CONCLUSION:

The first nationwide registry of patients with ACS in the Kingdom of Saudi Arabia is presented. In contrast to registries from developed countries, our cohort is characterized by a younger age at presentation and a much higher prevalence of diabetes mellitus. Most patients with STEMIs did not receive fibrinolytic therapy within the time recommended in the American College of Cardiology/American Heart Association guidelines. The results of the present pilot study show potential targets for improvement in care.     

Increased morbidity in diabetic cardiac transplant recipients

BACKGROUND:

Diabetes currently affects more than 7% of the Canadian population, and heart failure is a well-documented complication of diabetes. The medical management of heart failure is often limited by disease progression, and cardiac transplantation is a key therapeutic option in end-stage disease. However, both American and Canadian guidelines continue to list diabetes as a relative contraindication to cardiac transplantation.

OBJECTIVE:

To determine the effect of preoperative diabetes on morbidity and mortality in patients undergoing cardiac transplantation.

METHODS:

A retrospective analysis of 136 adult patients undergoing cardiac transplantation at the London Health Sciences Centre (London, Ontario) between February 1995 and November 2003 was performed. Preoperatively, 14% of patients were diabetic. Unpaired Student’s t tests and χ² tests were used to compare outcomes between diabetic and nondiabetic cardiac transplant recipients.

RESULTS:

Diabetic and nondiabetic cardiac transplant recipients were similar in age, sex, body mass index and ischemic time. Preoperatively, diabetic recipients had a higher mean serum glucose and an increased incidence of ischemic cardiomyopathy. At three years postcardiac transplantation, diabetic recipients were found to have increased rates of transplant coronary artery disease, as well as decreased cardiac function. However, diabetic and nondiabetic patients showed no differences in rates of clinically significant infection or rejection in the first three postoperative months. Furthermore, survival rates were similar between these two groups.

CONCLUSION:

Diabetes is not a contraindication to cardiac transplantation, but increased vigilance is warranted in this population to minimize postoperative morbidity.     

Association between Helicobacter pylori Seropositivity and the Coronary Artery Calcium Score in a Screening Population

Background/Aims

Helicobacter pylori causes numerous extragastric manifestations, including coronary heart disease. The coronary artery calcification (CAC) score, measured using computed tomography (CT) has been used as a screening test for coronary atherosclerosis. This study investigated the association between H. pylori seropositivity and CAC scores in a screening population.

Methods

Patients who underwent a health checkup between October 2003 and July 2007 and who did not have a history of ischemic heart disease were enrolled in the study. Subjects were screened with a multidetector CT scan to determine the CAC score and for anti-H. pylori antibody immunoglobulin G; traditional risks for coronary heart disease were evaluated using a structured questionnaire, anthropometric measurements, and laboratory tests.

Results

Of the 2,029 subjects enrolled (1,295 males), 1,214 (59.8%) subjects were H. pylori positive and 815 were H. pylori negative. There were no significant differences in the baseline characteristics of the seropositive and seronegative patients. When the CAC presence or absence scores were considered, multivariate analysis revealed that H. pylori seropositivity was statistically associated with the presence of CAC and that this association was stronger in the mild CAC score category.

Conclusions

H. pylori seropositive patients are at a higher risk for coronary atherosclerosis regardless of traditional cardiovascular risk factors. This association is particularly applicable for early coronary atherosclerosis.     

Spectral Analysis Related to Bare-Metal and Drug-Eluting Coronary Stent Implantation

Background

The autonomic nervous system plays a central role in cardiovascular regulation; sympathetic activation occurs during myocardial ischemia.

Objective

To assess the spectral analysis of heart rate variability during stent implantation, comparing the types of stent.

Methods

This study assessed 61 patients (mean age, 64.0 years; 35 men) with ischemic heart disease and indication for stenting. Stent implantation was performed under Holter monitoring to record the spectral analysis of heart rate variability (Fourier transform), measuring the low-frequency (LF) and high-frequency (HF) components, and the LF/HF ratio before and during the procedure.

Results

Bare-metal stent was implanted in 34 patients, while the others received drug-eluting stents. The right coronary artery was approached in 21 patients, the left anterior descending, in 28, and the circumflex, in 9. As compared with the pre-stenting period, all patients showed an increase in LF and HF during stent implantation (658 versus 185 ms2, p = 0.00; 322 versus 121, p = 0.00, respectively), with no change in LF/HF. During stent implantation, LF was 864 ms2 in patients with bare-metal stents, and 398 ms2 in those with drug-eluting stents (p = 0.00). The spectral analysis of heart rate variability showed no association with diabetes mellitus, family history, clinical presentation, beta-blockers, age, and vessel or its segment.

Conclusions

Stent implantation resulted in concomitant sympathetic and vagal activations. Diabetes mellitus, use of beta-blockers, and the vessel approached showed no influence on the spectral analysis of heart rate variability. Sympathetic activation was lower during the implantation of drug-eluting stents.     

An analysis of the risk factors for premature coronary artery disease in young and middle-age Chinese patients with hypertension

BACKGROUND:

Hypertension has become prevalent among young and middle-age individuals. Many studies have identified a variety of risk factors for cardiovascular diseases, yet there have been few reports focusing on the young and middle-age hypertensive population.

OBJECTIVE:

To investigate the epidemiological characteristics of conventional risk factors of premature coronary artery disease (PCAD) in patients with hypertension.

METHODS:

The clinical and laboratory data of 267 hypertensive patients with PCAD and 96 hypertensive patients without any visible coronary disease according to angiography were compared. Potential coronary risk factors were analyzed using logistic regression.

RESULTS:

The PCAD group had lower levels of high-density lipoprotein cholesterol (HDL-C) (P<0.05). Multivariate logistic analysis showed positive family history, low HDL-C, hypertriglyceridemia, duration of diabetes mellitus and male sex were significantly associated with PCAD (P<0.05), with ORs of 12.317, 3.267, 2.894, 1.140 and 0.088, respectively. Plasma renin activities in PCAD patients were significantly higher than in control hypertensive patients (P=0.027), but there was no significant difference in angiotensin II and aldosterone levels between the two groups.

CONCLUSION:

Low HDL-C and hypertriglyceridemia are important coronary risk factors in Chinese individuals with hypertension.     

Effect of pimobendan in patients with chronic heart failure

OBJECTIVE:

To assess the effects of a calcium sensitizer, pimobendan, in patients with mild to moderate chronic heart failure.

PATIENTS AND METHODS:

Pimobendan was administered at a dose of 2.5 mg/day for 12 months to 34 patients with chronic heart failure (New York Heart Association functional class IIm to III) after treatment with diuretics and angiotensin-converting enzyme inhibitors. The etiologies of heart failure were dilated cardiomyopathy (DCM), old myocardial infarction (OMI) and other heart disease (Others). The effects of pimobendan were assessed by echocardiography, blood pool scintigraphy, Holter monitoring, ¹²³I-meta-iodobenzylguanidine (MIBG) imaging and ¹²³I-β-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) imaging.

RESULTS:

Pimobendan produced improvement of symptoms in the majority of patients. Improvement was more common in the DCM group than in the OMI group. Left ventricular internal diameter measured by echocardiography was significantly decreased. Left ventricular ejection fraction was significantly increased in the DCM and Others groups. The heart to mediastinum ratio on MIBG imaging was significantly increased in the DCM and Others groups, and the heart to mediastinum ratio on BMIPP imaging was significantly increased in the DCM group.

CONCLUSIONS:

Pimobendan is effective in patients with chronic heart failure but is less effective in patients with OMI than in patients with DCM or other heart diseases.     

Prevalence of Rheumatic Heart Disease in a Public School of Belo Horizonte

Background

Previous studies indicate that compared with physical examination, Doppler echocardiography identifies a larger number of cases of rheumatic heart disease in apparently healthy individuals.

Objectives

To determine the prevalence of rheumatic heart disease among students in a public school of Belo Horizonte by clinical evaluation and Doppler echocardiography.

Methods

This was a cross-sectional study conducted with 267 randomly selected school students aged between 6 and 16 years. students underwent anamnesis and physical examination with the purpose of establishing criteria for the diagnosis of rheumatic fever. They were all subjected to Doppler echocardiography using a portable machine. Those who exhibited nonphysiological mitral regurgitation (MR) and/or aortic regurgitation (AR) were referred to the Doppler echocardiography laboratory of the Hospital das Clínicas of the Universidade Federal of Minas Gerais (HC-UFMG) to undergo a second Doppler echocardiography examination. According to the findings, the cases of rheumatic heart disease were classified as definitive, probable, or possible.

Results

Of the 267 students, 1 (0.37%) had a clinical history compatible with the diagnosis of acute rheumatic fever (ARF) and portable Doppler echocardiography indicated nonphysiological MR and/or AR in 25 (9.4%). Of these, 16 (6%) underwent Doppler echocardiography at HC-UFMG. The results showed definitive rheumatic heart disease in 1 student, probable rheumatic heart disease in 3 students, and possible rheumatic heart disease in 1 student.

Conclusion

In the population under study, the prevalence of cases compatible with rheumatic involvement was 5 times higher on Doppler echocardiography (18.7/1000; 95% CI 6.9/1000-41.0/1000) than on clinical evaluation (3.7/1000-95% CI).     

Predictive Factors for Severe Outcomes in Ischemic Colitis

Background/Aims

Ischemic colitis includes a wide clinical spectrum ranging from mild to severe forms. This study aimed to determine the factors that are related to the occurrence of severe ischemic colitis.

Methods

This multicenter study was conducted retrospectively in Korea. The patients were divided into mild and severe groups. This study surveyed clinical characteristics, blood tests, endoscopic findings, and imaging studies.

Results

In the comparison of comorbidities, the severe group had a higher ratio of chronic kidney disease than the mild group (p=0.001). In the blood test, the severe group had a reduced number of platelets (p=0.018) and a higher C-reactive protein value (p=0.001). The severe group had a higher ratio of involvement of the right colon (p=0.026). The Eastern Cooperative Oncology Group (ECOG) performance status score of the patients showed that the severe group had higher scores than the mild group (p=0.003). A multivariate analysis showed that chronic kidney disease and high ECOG performance status scores were significant risk factors.

Conclusions

If patients diagnosed with ischemic colitis are also treated for chronic kidney disease or have poor performance status, more attention and early intervention are necessary.     

Differences in the predictive value of red cell distribution width for the mortality of patients with heart failure due to various heart diseases

Background Increased red blood cell distribution width (RDW) is associated with adverse outcomes in patients with heart failure (HF). The objective of this study was to compare the differences in the predictive value of RDW in patients with HF due to different causes. Methods We retrospectively investigated 1,021 HF patients from October 2009 to December 2011 at Fuwai Hospital (Beijing, China). HF in these patients was caused by three diseases; coronary heart disease (CHD), dilated cardiomyopathy (DCM) and valvular heart disease (VHD). Patients were followed-up for 21 ± 9 months. Results The RDW, mortality and survival duration were significantly different among the three groups. Kaplan–Meier analysis showed that the cumulative survival decreased significantly with increased RDW in patients with HF caused by CHD and DCM, but not in those with HF patients caused by VHD. In a multivariable model, RDW was identified as an independent predictor for the mortality of HF patients with CHD (P < 0.001, HR 1.315, 95% CI 1.122–1.543). The group with higher N-terminal pro-brain natriuretic peptide (NT-proBNP) and higher RDW than median had the lowest cumulative survival in patients with HF due to CHD, but not in patients with HF due to DCM. Conclusions RDW is a prognostic indicator for patients with HF caused by CHD and DCM; thus, RDW adds important information to NT-proBNP in CHD caused HF patients.     

Prevalence and risk factors of aortic aneurysm in patients with chronic obstructive pulmonary disease

Background

Patients with chronic obstructive pulmonary disease (COPD) manifest an excess of chronic co-morbidities and present a high prevalence of cardiovascular disease such as congestive heart failure and ischemic heart disease. Aortic aneurysm (AA) also shared the risks of those diseases and its rupture is an important cause of death. However, since AA progresses almost silently, the prevalence of AA in patients with COPD remains unclear. The aim of this study was to determine AA prevalence and risk factors in patients with COPD.

Methods

With computed tomography (CT) screening, we tested for AA in 231 COPD patients, and assessed emphysema by Goddard classification and aortic wall calcification in abdominal artery, respectively. We also evaluated that of thoracic artery using our original methods, which we assessed the extent of calcification in the thoracic artery as well as which defined as “aortic calcification index (ACI) in thoracic artery”.

Results

In 231 patients with COPD, 27 (11.7%) had AA determined by CT imaging and another 6 patients with previously diagnosed AA and a history of repaired operation (2.6%). In this total of 33 patients (AA group), the age of 95% confidence interval (CI) was 75.8 to 80.1 years and the prevalence of AA in patients aged 76 to 80 years was 26.8%. A low attenuation area and aortic wall calcification were more severe in the AA group than in the non-AA group, but forced expiratory volume in 1 second (FEV₁) was not significantly different in those patients. The Goddard score of nine and ACI in the thoracic artery of 25.0% were determined to identify the most appropriate cut-off levels for discriminating between AA and non-AA groups.

Conclusions

Our analysis indicated that sizeable under-recognition of AA seems likely in COPD. Especially for patients with severe lung destruction and aortic calcification verifiable by chest CT, abdominal CT would be beneficial for detecting AA.     

Nocturnal Hemodialysis Is Associated with Restoration of Early-Outgrowth Endothelial Progenitor-Like Cell Function

Summary

Background and objectives

Angiogenesis is a key response to tissue ischemia that may be impaired by uremia. Although early-outgrowth endothelial progenitor-like cells promote angiogenesis in the setting of normal renal function, cells from uremic patients are dysfunctional. When compared with conventional hemodialysis, it was hypothesized that nocturnal hemodialysis would improve the in vivo angiogenic activity of these cells in a well described model of ischemic vascular disease.

Design, setting, participants, and measurements

Early-outgrowth endothelial progenitor-like cells were cultured from healthy controls (n = 5) and age- and gender-matched conventional hemodialysis (12 h/wk, n = 10) and nocturnal hemodialysis (30 to 50 h/wk, n = 9) patients. Cells (5 × 10⁵) or saline were injected into the ischemic hindlimb of athymic nude rats 1 day after left common iliac artery ligation.

Results

Although conventional dialysis cell injection had no effect versus saline, nocturnal hemodialysis and healthy control cell injection significantly improved ischemic hindlimb perfusion and capillary density. Nocturnal hemodialysis cell injection was also associated with significant increases in endogenous angiopoietin 1 expression in the ischemic hindlimb compared with saline and conventional dialysis cell injection.

Conclusions

In contrast to a conventional dialytic regimen, nocturnal hemodialysis is associated with a significantly improved ability of early-outgrowth endothelial progenitor-like cells to promote angiogenesis and thus restore perfusion in a model of ischemic vascular disease.     

Ergospirometry and Echocardiography in Early Stage of Heart Failure with Preserved Ejection Fraction and in Healthy Individuals

Background

Heart failure with preserved ejection fraction is a syndrome characterized by changes in diastolic function; it is more prevalent among the elderly, women, and individuals with systemic hypertension (SH) and diabetes mellitus. However, in its early stages, there are no signs of congestion and it is identified in tests by adverse remodeling, decreased exercise capacity and diastolic dysfunction.

Objective

To compare doppler, echocardiographic (Echo), and cardiopulmonary exercise test (CPET) variables - ergospirometry variables - between two population samples: one of individuals in the early stage of this syndrome, and the other of healthy individuals.

Methods

Twenty eight outpatients diagnosed with heart failure according to Framingham’s criteria, ejection fraction > 50% and diastolic dysfunction according to the european society of cardiology (ESC), and 24 healthy individuals underwent Echo and CPET.

Results

The group of patients showed indexed atrial volume and left ventricular mass as well as E/E’ and ILAV/A´ ratios significantly higher, in addition to a significant reduction in peak oxygen consumption and increased VE/VCO₂ slope, even having similar left ventricular sizes in comparison to those of the sample of healthy individuals.

Conclusion

There are significant differences between the structural and functional variables analyzed by Echo and CPET when comparing two population samples: one of patients in the early stage of heart failure with ejection fraction greater than or equal to 50% and another of healthy individuals.     

Asymptomatic Brain Lesions on Cranial Magnetic Resonance Imaging in Inflammatory Bowel Disease

Background/Aims

This study aimed to examine the frequency and type of asymptomatic neurological involvement in inflammatory bowel disease (IBD) using cranial magnetic resonance imaging (MRI).

Methods

Fifty-one IBD patients with no known neurological diseases or symptoms and 30 controls with unspecified headaches without neurological origins were included. Patients and controls underwent cranial MRI assessments for white matter lesions, sinusitis, otitis-mastoiditis, and other brain parenchymal findings.

Results

The frequencies of white matter lesions, other brainstem parenchymal lesions, and otitis-mastoiditis were similar in IBD patients and controls (p>0.05), whereas sinusitis was significantly more frequent in IBD patients (56.9% vs 33.3%, p=0.041). However, among those subjects with white matter lesions, the number of such lesions was significantly higher in IBD patients compared to controls (12.75±9.78 vs 3.20±2.90, p<0.05). The incidence of examined pathologies did not differ significantly with disease activity (p>0.05 for all).

Conclusions

The incidence of white matter lesions seemed to be similar in IBD patients and normal healthy individuals, and the lesions detected did not pose any clinical significance. However, long-term clinical follow-up of the lesions is warranted.