A counterpoint paper: Comments on the electrocardiographic part of the 2018 Fourth Universal Definition of Myocardial Infarction endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology

The Fourth Universal Definition of Myocardial Infarction (FUDMI) focuses on the distinction between nonischemic myocardial injury and myocardial infarction (MI), along with the role of cardiovascular magnetic resonance, in order to define the etiology of myocardial injury. As a consequence, there is less emphasis on updating the parts of the definition concerning the electrocardiographic (ECG) changes related to MI. Evidence of myocardial ischemia is a prerequisite for the diagnosis of MI, and the ECG is the main available tool for (a) detecting acute ischemia, (b) triage, and (c) risk stratification upon presentation. This review focuses on multiple aspects of ECG interpretation that we firmly believe should be considered for incorporation in any future update to the Universal Definition of MI.     

Evolocumab Effects on Lipoproteins,Measured by High-Performance Liquid Chromatography

Aims: Profiling of lipoproteins can predict risk of cardiovascular disease; gel permeation high-performance liquid chromatography (HPLC) improves prediction accuracy by providing detailed data for specific lipoprotein subclasses. This study applied HPLC to examine the effects of evolocumab, which effectively treats hyperlipidemia and mixed dyslipidemia, on lipoprotein subclasses, specifically the number and size of lipoprotein particles.Methods: This post-hoc analysis used patient blood samples from YUKAWA-2, a phase 3 trial evaluating the efficacy of evolocumab in Japanese adult patients with hyperlipidemia or mixed dyslipidemia and at high risk for cardiovascular disease. We used HPLC to assess observed values and percent change from baseline in cholesterol and triglyceride (TG) concentrations, number of particles in lipoprotein subclasses to week 12, and mean observed values and mean percent change from baseline in variables to weeks 10 and 12. HPLC was also compared with conventional methods in assessing low-density lipoprotein (LDL) cholesterol (LDL-C) values.Results: Data for all 404 patients were analyzed. Evolocumab significantly decreased cholesterol and TG concentrations, and total particle count, in very low-density lipoprotein (VLDL) and LDL subclasses. Particle size increased slightly in LDL, high-density lipoprotein (HDL), and VLDL, but data varied widely. At very low L-DLC, HPLC measurements were higher than those from conventional methods.Conclusion: This research used HPLC to assess the effects of evolocumab in 20 lipid subclasses. By lowering lipid content and improving the lipid profile, evolocumab may reduce atherogenicity. This reduction is better quantified by HPLC than by conventional methods in the very low LDL-C range.     

Role of Aliskiren on Arterial Stiffness and Endothelial Function in Patients With Primary Hypertension

Arterial stiffness and endothelial dysfunction are important determinants of cardiovascular events in patients with arterial hypertension. There are few data regarding the role of aliskiren on the central hemodynamics and endothelial function in patients with uncontrolled arterial hypertension. The aim of this study was to assess the addition of aliskiren to other antihypertensive drug treatment for arterial stiffness and endothelial function. Thirty uncontrolled hypertensive patients (mean age, 60.4±12.2 years), without any other cardiovascular risk factors, were enrolled. Augmentation index (AIx) and carotid‐femoral pulse wave velocity (cfPWV) by applanation tonometry and reactive hyperemia peripheral arterial tonometry (RH PAT) index using peripheral arterious tonometry at baseline and after 6 months of aliskiren titrated to 300 mg once a day was evaluated. The addition of aliskiren had no effect on values of central AIx (33.26±10.74% vs 28.86±10.74%; P=.36) but did significantly improve values of cfPWV (9.36±2.65 m/s vs 8.72±2.48 m/s; P=.04) and RH PAT index (1.64±0.57 vs 1.75±0.45; P=.05). In addition to improving systolic and diastolic blood pressure, the addition of aliskiren to concomitant antihypertensive drugs in uncontrolled hypertensive patients may be effective in improving aortic stiffness and endothelial function. These results encourage further studies to evaluate the use of aliskiren for cardiovascular prevention.     

Comparison of Different Parameters to Evaluate Delamination in Edge Trimming of Basalt Fiber Reinforced Plastics (BFRP)

Delamination is one of the main problems that occur when machining fiber-reinforced composite materials. In this work, Types I and II of delamination are studied separately in edge trimming of basalt fiber reinforced plastic (BFRP). For this purpose, one-dimensional and area delamination parameters are defined. One-dimensional parameters (Wa and Wb) allow to know average fibers length while the analysis of area delamination parameters (Sd) allow to evaluate delamination density. To study delamination, different tests are carried out modifying cutting parameters (cutting speed, feed per tooth and depth of cut) and material characteristics (fiber volume fraction and fiber orientation). Laminates with a lower fiber volume fraction do not present delamination. Attending to one-dimensional parameters it can be concluded that Type II delamination is more important than Type I and that a high depth of cut generates higher values of delamination parameters. An analysis of variance (ANOVA) is performed to study area parameters. Although delamination has a random nature, for each depth of cut, more influence variables in area delamination are firstly, feed per tooth and secondly, cutting speed.