Long-term angiographic follow up, cardiac events, and survival in patients undergoing percutaneous transluminal coronary angioplasty

The results of percutaneous transluminal coronary angioplasty were studied in 1352 consecutive patients. The angioplasty procedure was angiographically successful in 1163 (86%) patients and the success rate increased gradually with time. There were no significant differences in success rates in different vessels or indications. The success rate for repeat coronary angioplasty was 92%. In 85% of the patients the clinical course was uncomplicated. Myocardial infarction occurred in 3.6%, emergency coronary bypass grafting in 2.6%, elective bypass surgery in 4.6%, and there were 10 deaths (0.7%). There were 16 deaths (10 non-cardiac) during follow up in the 1163 patients in whom the first procedure was successful. Actuarial analysis showed that after a first angioplasty 77.9% remained free of symptoms and cardiac events for five years and that after a second angioplasty 76% did so. Angiographic follow up showed restenosis in 24% of patients but the overall clinical success rate was 86.2%. On the basis of the intention to treat the procedure was successful in 74.3% of all 1352 patients. Coronary artery bypass surgery was eventually performed in 11.6% of all patients. The long term angiographic success rate of coronary angioplasty is higher than previously suggested.     

Balloon angioplasty of coarctation of the aorta: a safe alternative for surgery in adults: immediate and mid-term results.

Patients with coarctation of the aorta can be treated either with surgery or with balloon angioplasty. So far, the last method has proved to be successful in children, but results of this treatment in (young) adults are virtually unknown. The aim of this study was to evaluate the immediate and mid-term follow-up results of balloon angioplasty of native coarctation in (mainly young) adults. Coarctation of the aorta was diagnosed by means of ultrasound or angiography, and defined as a stenosis with a pressure gradient greater than 20 mm Hg. The balloon angioplasty-procedure was carried out under complete anesthesia, and was considered to be successful, if the pressure gradient was reduced to less than 20 mm Hg. Nineteen consecutive adults (12 males, 7 females; aged 14-67 years, median 29) with native coarctation were treated from 1995-99. Mean pressure gradient decreased from 49.3+/- 20.8 to 4.8+/-8.2 mm Hg (P<0.0001). One patient showed a suboptimal result with a residual pressure gradient of 28 mm Hg. In one other patient a stent was placed on request of the referring physician. Follow-up was 100% complete and ranged from 3-47 months (mean 20.2+/- 12.9). At 1-year follow-up mean systolic blood pressure was reduced from 159.4+/-19.5 to 132.5+/-17.6 mm Hg (n = 18; P<0.0001), and mean ankle-arm pressure index improved from 0.73+/-0.09 to 0.96+/-0.05 (n = 18; P<0.0001). Anti-hypertensive medication could either be reduced or stopped in 7 patients (53.8%). With ultrasound or angiography or MRI, no patients had signs of aneurysm formation or worsening restenosis during follow-up. In adult patients with uncomplicated native coarctation of the aorta, balloon angioplasty (without stenting) would seem to be an excellent and safe alternative for surgery. In our hospital it has completely replaced surgical correction in such patients.     

Myocardial involvement in acromegaly

We recently encountered a case of an acromegalic patient with congestive heart failure and secondary cardiomyopathy. Cardiac biopsies were available in addition to autopsy material. This enabled us to perform electron microscopical studies which have hitherto not been reported. This may help to clarify the relationship between these two conditions and reveal specific characteristics.     

A randomized trial assessing the effect of coumarins started before coronary angioplasty on restenosis: results of the 6-month angiographic substudy of the Balloon Angioplasty and Anticoagulation Study (BAAS)

Background Thrombus formation during coronary angioplasty may play a role in the restenosis process.Methods The effect of pretreatment with coumarins on 6-month angiographic outcome was studied. In addition, the effect of “optimal” anticoagulation, defined as an international normalized ratio >70% of the follow-up time in the target range, was studied. A total of 261 patients were assigned to aspirin alone (ASA group) and 270 patients to aspirin plus coumarins started 1 week before the procedure (coumarin group).Results The mean international normalized ratio was 2.7 ± 1.2 at the start of the procedure and 3.1 ± 0.5 during follow up. Quantitative coronary analysis was performed on 301 lesions in the ASA group and of 297 lesions in the coumarin group. At 6 months, the minimal luminal diameter was similar in the ASA and coumarin groups. Optimal anticoagulation, however, was an independent predictor of a larger minimal luminal diameter at follow up (P = .01).Conclusion Overall, coumarins do not improve angiographic outcome 6 months after coronary angioplasty. (Am Heart J 2003;145:58-65.)     

Activation of leukocytes by postprandial lipemia in healthy volunteers

Activation of leukocytes is obligatory for inflammation and atherogenesis by adhering to the endothelium via specific ligands. Although in vitro studies have shown that triglycerides (TG) can activate leukocytes, it is unknown whether this occurs in vivo. Using flowcytometry, we studied the expression of leukocyte activation markers CD11A, CD11B, CD62L (all involved in endothelium adhesion) and CD66B (a neutrophil degranulation marker) during a 6 h fat challenge (50 g/m2) and a water test in 10 healthy males (52 +/- 3 years). After fat, neutrophil counts were increased between t=1 and t =6 h, with a maximum at t=3 h (+32% versus t=0, P <0.05), while they remained unchanged after water. Both tests showed gradual lymphocyte count increments. The expression of activation markers on lymphocytes was low and showed comparable responses after both tests. After fat, a significant increase up to a maximum at t=6 h was seen for CD11B on monocytes and on neutrophils for CD11B, CD62L and CD66B. Postprandial activation of monocytes and neutrophils was higher after fat than after water. The maximal postprandial TG increment was significantly related to the increase of CD11B on monocytes (Pearson's R=0.64, P <0.05). In conclusion, postprandially there is a TG-specific increase of neutrophil counts and increased activation of monocytes and neutrophils. These results are suggestive of a pro-inflammatory situation that may correspond with increased adhesive capacity of these cells contributing to the inflammatory component of atherosclerosis.     

Liver X receptors orchestrate osteoblast/osteoclast crosstalk and counteract pathologic bone loss

Osteoporosis is characterized by enhanced differentiation of bone‐resorbing osteoclasts, resulting in a rapid loss of functional trabecular bone. Bone‐forming osteoblasts and osteoblast‐derived osteocytes perform a key role in the regulation of osteoclast development by providing both the pro‐osteoclastogenic cytokine receptor activator of NF‐κB ligand (RANKL) and its natural decoy receptor osteoprotegerin (OPG). By regulating the RANKL/OPG ratio, osteoblasts hence determine the rate of both osteoclast differentiation and bone turnover. Here, we describe a novel role for liver X receptors (LXRs) during the crosstalk of bone‐forming osteoblasts and bone‐resorbing osteoclasts. By using a system of osteoblast/osteoclast cocultures, we identify LXRs as regulator of RANKL expression and the RANKL/OPG ratio in osteoblasts. Activation of LXRs drastically reduced the RANKL/OPG ratio and interfered with osteoblast‐mediated osteoclast differentiation in vitro. During an ovariectomy (OVX)‐induced model of postmenopausal osteoporosis, the application of an LXR agonist shifted the RANKL/OPG ratio in vivo, ameliorated the enhanced osteoclast differentiation, and provided complete protection from OVX‐induced bone loss. These results reveal an unexpected involvement of LXRs in the regulation of bone turnover and highlight a potential role for LXRs as novel targets in the treatment of osteoporosis and related diseases. © 2012 American Society for Bone and Mineral Research.     

三叶鼠尾草中小红参醌丙的结构

从三叶鼠尾草(Salvia trijuga Diels)的干燥根中分得9种结晶性成分,经鉴定为铁锈醇(ferruginol)、柳杉酚(sugiol)及系列高级脂肪酸三十四酸、三十酸、二十八酸、十六酸,另两种酸分别为对羟苯甲酸及氨基酸(dl-homoserine),晶Ⅰ为一新化合物,定名为小红参醌丙(trijuganone C),经光谱分析及化学反应推定其结构为15,16-二氢丹参酸甲酯。