RESUMEN
BACKGROUND: Left ventricular aneurysm (LVA) is an important complication of acute myocardial infarction. This study aimed to investigate the potential predictive value of the monocyte count to high-density lipoprotein cholesterol ratio (MHR) and a composite risk score in determining the formation of LVA in patients with acute ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention. METHODS: We recruited 1005 consecutive patients with STEMI. Multivariable logistic regression analysis was conducted identify the independent risk factors for LVA formation. Predictive power of MHR and composite risk score for LVA formation were assessed using receiver operating characteristic curve analysis. RESULTS: The MHR was significantly higher among patients with LVA compared to those without LVA [6.6 (3.8-10.8) vs. 4.6 (3.3-6.3), P â <â 0.001]. Univariable logistic regression analysis revealed that MHR (ORâ =â 3.866, 95% CIâ =â 2.677-5.582, P â <â 0.001) was associated with the risk of LVA formation. The predictive value of MHR remained significant even after multivariate logistic regression analysis [odds ratio (OR)â =â 4.801, 95% confidence interval (CI)â =â 2.672-8.629, P â <â 0.001]. The discriminant power of MHR for LVA is 0.712, which is superior to both monocyte ( C statisticâ =â 0.553) and high-density lipoprotein cholesterol ( C statisticâ =â 0.654). The composite risk score including MHR, gender, LVEF, hemoglobin, lymphocyte and left anterior descending artery as the culprit vessel could significantly increase the predictive ability ( C statisticâ =â 0.920). CONCLUSION: A higher MHR could effectively identify individuals at high risk of LVA formation, especially when combined with gender, LVEF, hemoglobin, lymphocyte and left anterior descending artery as the culprit vessel.
Asunto(s)
Biomarcadores , HDL-Colesterol , Aneurisma Cardíaco , Monocitos , Intervención Coronaria Percutánea , Valor Predictivo de las Pruebas , Infarto del Miocardio con Elevación del ST , Humanos , Masculino , Femenino , Infarto del Miocardio con Elevación del ST/sangre , Infarto del Miocardio con Elevación del ST/complicaciones , Persona de Mediana Edad , HDL-Colesterol/sangre , Factores de Riesgo , Intervención Coronaria Percutánea/métodos , Medición de Riesgo/métodos , Anciano , Aneurisma Cardíaco/sangre , Aneurisma Cardíaco/complicaciones , Biomarcadores/sangre , Curva ROC , Análisis Multivariante , Modelos Logísticos , Recuento de Leucocitos , Ventrículos Cardíacos/fisiopatología , Ventrículos Cardíacos/diagnóstico por imagen , Estudios Retrospectivos , Área Bajo la Curva , Oportunidad RelativaRESUMEN
BACKGROUND: Left ventricular aneurysm (LVA) relates to worse prognosis in patients with myocardial infarction despite successful reperfusion treatment. There is no evidence that early detectable biomarkers can predict the risk for the future development of LVA. AIM: The aim of our study was to investigate the possible predictive value of periprocedural haematological parameters for LVA. METHODS: A total of 281 patients with acute anterior ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (pPCI) were enrolled. Haematological parameters were measured on admission before pPCI and between 8 and 12 h after pPCI, separately. The development of LVA was evaluated at one-year follow-up. The patients were then divided into two groups: an LVA group and a non-LVA group. Univariate and multivariate logistic regression analyses were performed to find the predictors of LVA. RESULTS: A total of 34 (12.1%) patients developed LVA at one-year follow-up after pPCI. Multivariate analyses revealed that a 10 × 109/L increase in platelet count 12 h after pPCI (odds ratio [OR] 1.092, 95% confidence interval [CI] 1.015-1.188, p = 0.039), peak cardiac troponin I (OR 1.107, 95% CI 1.003-1.215, p = 0.000), and left ventricular ejection fraction (OR 0.853, 95% CI 0.772-0.943, p = 0.002) were independent risk factors for LVA. For the prediction of LVA, platelet count 12 h after pPCI at a cut-off value > 197 × 109/L yielded a receiver operating characteristic-area under the curve (ROC-AUC) of 0.635 (82.3% sensitivity, 44.1% specificity). CONCLUSIONS: Platelet count after pPCI was significantly associated with the development of LVA in anterior STEMI patients and may be available for early risk stratification of future LVA formation.
Asunto(s)
Aneurisma Cardíaco/sangre , Ventrículos Cardíacos , Intervención Coronaria Percutánea , Recuento de Plaquetas , Infarto del Miocardio con Elevación del ST/cirugía , Anciano , Área Bajo la Curva , Biomarcadores/sangre , Femenino , Aneurisma Cardíaco/etiología , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Curva ROC , Infarto del Miocardio con Elevación del ST/complicaciones , Disfunción Ventricular IzquierdaRESUMEN
A coupled chemo-fluidic computational model for investigating flow-mediated thrombogenesis in infarcted left ventricles (LVs) is proposed. LV thrombus (LVT) formation after the acute myocardial infarction (AMI) may lead to thromboembolic events that are associated with high mortality and morbidity, and reliable stratification of LVT risk is the key to managing the treatment of AMI patients. There have been several studies emphasizing the importance of LV blood flow patterns on thrombus formation; however, given the complex interplay between ventricular flow dynamics and biochemistry of thrombogenesis, current understanding is mostly empirical. In the present model, blood flow in the LV is obtained by solving the incompressible Navier-Stokes equations, and this is coupled to the biochemical modeling of the coagulation cascade, platelet activation, and fibrinogen polymerization. The coupled model is used to examine the effect of ventricular flow patterns on thrombogenesis in modeled ventricles. It is expected that the method developed here will enable in-depth studies of thrombogenesis in patient-derived infarcted LV models.
Asunto(s)
Coagulación Sanguínea , Simulación por Computador , Aneurisma Cardíaco/sangre , Ventrículos Cardíacos/metabolismo , Hemodinámica , Modelos Cardiovasculares , Infarto del Miocardio con Elevación del ST/sangre , Trombosis/sangre , Velocidad del Flujo Sanguíneo , Plaquetas/metabolismo , Fibrinógeno/metabolismo , Aneurisma Cardíaco/diagnóstico por imagen , Aneurisma Cardíaco/fisiopatología , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Hidrodinámica , Activación Plaquetaria , Flujo Sanguíneo Regional , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/fisiopatología , Trombosis/diagnóstico por imagen , Trombosis/fisiopatología , Factores de Tiempo , Tomografía Computarizada por Rayos XAsunto(s)
Tabique Interatrial , Aneurisma Cardíaco/sangre , Linfocitos , Neutrófilos , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: Systemic thromboembolism is a serious, major complication in patients with an atrial septal aneurysm (ASA). Paroxysmal atrial fibrillation (AF) is more common in patients with ASA than in the normal population. Neutrophil/lymphocyte ratio (NLR) has been associated with postoperative AF development in patients who have undergone cardiac surgery. This study investigated NLR in a group of ASA patients compared with a control group of healthy volunteers. PATIENTS AND METHODS: The study group consisted of 40 patients with ASA; the control group consisted of 30 age-, sex-, and body mass index-matched healthy volunteers. All patients and control subjects underwent echocardiographic examination. No patient had a recent history of an acute infection or an inflammatory disease. Baseline NLR was measured by dividing neutrophil count by lymphocyte count. RESULTS: No statistically significant difference was found between the two groups in terms of basic characteristics. Mean NLR was significantly higher among persons with ASA compared with controls (3.4 ± 1.5 vs 1.6 ± 0.97, P < 0.001). CONCLUSION: Our results suggest that a higher NLR, an emerging marker of inflammation, has a positive correlation with ASA. The measurement of NLR may be used to indicate an increased risk of arrhythmia, such as AF, in ASA patients.
Asunto(s)
Tabique Interatrial , Aneurisma Cardíaco/sangre , Linfocitos , Neutrófilos , Adulto , Anciano , Tabique Interatrial/diagnóstico por imagen , Estudios de Casos y Controles , Ecocardiografía Doppler en Color , Electrocardiografía , Femenino , Aneurisma Cardíaco/diagnóstico por imagen , Aneurisma Cardíaco/inmunología , Humanos , Recuento de Linfocitos , Linfocitos/inmunología , Masculino , Persona de Mediana Edad , Neutrófilos/inmunología , Valor Predictivo de las PruebasRESUMEN
BACKGROUND: Left ventricular aneurysm (LVA) is a serious complication of myocardial infarction and reduces the chances of survival. Controversy still exists regarding the optimal surgical technique for LVA repair. We analyze the efficacy of two techniques, linear vs. endoventricular circular patch plasty, for repair of LVA and the efficacy of surgical ventricular restoration (SVR) on beating heart. METHODS: This study included 62 patients who underwent SVR from 1086 consecutive patients were subjected to coronary artery bypass grafting (CABG) between 2000 and 2009. All selected patients were divided either into group liner or patch according to the choice of the repair technique depended on factors such as localization, size and dimension of the scar. The patients also were divided either into group beating heart or cardioplegia. The pre-, intra- and postoperative relevant data of all selected patients were analyzed. RESULTS: The mortality was not significantly different between linear and patch repair groups, also the actuarial survival rates within 24 months (p= 0.529). Postoperative echocardiographic findings showed significant improvements in left ventricular function in both groups. The beating heart technique reduced postoperative peak release by 27% for Cardiac troponin I (cTnI) compared with the cardioplegia group (0.46 ± 0.06 ng/mL versus 0.63 ± 0.09 ng/mL, p= 0.004), and increased the perioperative survival by 9% (97.2% versus 88.5%), but the actuarial survival rates were not significantly different between the groups from 2 to 24 months (p= 0.151). CONCLUSIONS: Both techniques (linear and patch) achieved good results with respect to mortality, functional status and survival. The choice of surgical technique should be adapted in each patient. The beating heart technique may to some extent relieve myocardial injury in patients undergoing SVR.
Asunto(s)
Puente de Arteria Coronaria/métodos , Aneurisma Cardíaco/cirugía , Anciano , Análisis de Varianza , Femenino , Aneurisma Cardíaco/sangre , Paro Cardíaco Inducido , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Troponina I/sangre , Función Ventricular IzquierdaRESUMEN
Submitral aneurysm is a rare cardiac pathology of uncertain origin with varied clinical manifestations. Recent studies have revealed a congenital basis of this pathology, although genetic link has been suspected because of the racial predilection. The other suggested aetiologies are infection and inflammation. The case reported here is that of a young female with a large submitral aneurysm presenting in a state of cardiogenic shock. In addition, the presence of raised inflammatory parameters indicates that the cause of origin of this aneurysm is related to inflammation.
Asunto(s)
Aneurisma Cardíaco , Ventrículos Cardíacos , Adulto , Procedimientos Quirúrgicos Cardíacos , Ecocardiografía Transesofágica , Resultado Fatal , Femenino , Aneurisma Cardíaco/sangre , Aneurisma Cardíaco/complicaciones , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/cirugía , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/cirugía , Humanos , Mediadores de Inflamación/sangre , Factores de Riesgo , Choque Cardiogénico/etiología , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Aneurisma Falso/diagnóstico , Rotura Cardíaca Posinfarto/diagnóstico , Anciano , Aneurisma Falso/sangre , Aneurisma Roto/sangre , Aneurisma Roto/diagnóstico , Aneurisma Cardíaco/sangre , Aneurisma Cardíaco/diagnóstico , Rotura Cardíaca Posinfarto/sangre , Ventrículos Cardíacos/patología , Humanos , MasculinoRESUMEN
Diagnosis of patent foramen ovale (PFO) is commonly made by echocardiography with contrast injection. PFO can be responsible for a transient right-to-left shunting with paroxysmal dyspnoea but punctual measurements of oxygen saturation may fail to detect arterial desaturations. Thus, claiming the imputability of PFO in dyspnoeic symptoms remains difficult. We report on the case of a 64-year-old man presenting an intermittent disabilitating dyspnoea, for which the pulse oximetry monitoring allowed to impute symptoms to the right-to-left shunting through the PFO and influenced the decision of percutaneous closure.
Asunto(s)
Disnea/etiología , Defectos del Tabique Interatrial/diagnóstico , Monitoreo Ambulatorio , Oximetría , Disnea/sangre , Ecocardiografía Transesofágica , Electrocardiografía Ambulatoria , Aneurisma Cardíaco/sangre , Aneurisma Cardíaco/diagnóstico , Defectos del Tabique Interatrial/sangre , Defectos del Tabique Interatrial/cirugía , Tabiques Cardíacos , Humanos , Hipertensión/sangre , Hipertensión/diagnóstico , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Remodelación Ventricular/fisiologíaRESUMEN
Idiopathic annular submitral left ventricular aneurysm has been described mainly in young Africans living in tropical countries. Association with peripartum cardiomyopathy has been previously pointed out. The purpose of this report is to describe 3 patients with idiopathic annular submitral left ventricular aneurysm identified in a series 50 patients with peripartum cardiomyopathy in Niamey, Republic of Niger. Anti-Chlamydia pneumoniae antibody status was determined in all 50 patients using the micro-immunofluorescence technique that differentiates IgG, IgA and IgM antibodies. Findings showed that all 3 patients with annular submitral left ventricular aneurysm had significantly elevated plasma IgG and IgA anti-Chlamydia pneumoniae antibody levels at the time of diagnosis. In one patient analysis of 2 samples collected 3 months apart indicated chronic elevation with exceptionally high IgG antibody levels (1/2048e). These previously unreported data suggest a possible link between Chlamydia pneumoniae and development of peripartum cardiomyopathy and annular submitral left ventricular aneurysm. This possibility is supported by recent evidence that specific IgA anti-Chlamydia pneumoniae antibodies may be predictive of aortic abdominal aneurysms.
Asunto(s)
Anticuerpos Antibacterianos/sangre , Chlamydophila pneumoniae/inmunología , Aneurisma Cardíaco/sangre , Cardiopatías/sangre , Válvula Mitral , Trastornos Puerperales/sangre , Adolescente , Adulto , Femenino , Aneurisma Cardíaco/complicaciones , Cardiopatías/complicaciones , Humanos , Niger , Trastornos Puerperales/complicacionesRESUMEN
In the uncomplicated course of myocardial infarction (MI), the level of endothelin-1 (ET-1) comes to be increased beginning from day 1 and remains the same during the acute phase of the disease and gets decreased during the subacute phase. In MI presenting with parietal thrombosis, left ventricular aneurism, the level of ET-1 increases during the first period of 24 hours, increasing further toward the end of the acute phase, there being no decrease in the subacute phase. In MI presenting with pericardial effusion, an increase in the level of ET-1 is seen during the first period of 24 hours of the disease with no rise being recordable in peptide concentration during the acute and subacute phases. There is a positive correlation between the level of ET-1 and size of the heart cavities in the systole and diastole, pressure in the pulmonary artery, and a negative one with indices for the systolic function.
Asunto(s)
Endotelina-1/sangre , Infarto del Miocardio/sangre , Infarto del Miocardio/complicaciones , Femenino , Aneurisma Cardíaco/sangre , Aneurisma Cardíaco/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Derrame Pericárdico/sangre , Derrame Pericárdico/complicaciones , Trombosis/sangre , Trombosis/complicacionesRESUMEN
OBJECTIVES: The aim of this study was to determine the significance of peripheral monocytosis in clinical outcome after reperfused acute myocardial infarction (AMI), especially relating to post-infarct left ventricular (LV) remodeling. BACKGROUND: Peripheral monocytosis occurs two to three days after AMI, reflecting infiltration of monocytes and macrophages into the necrotic myocardium. However, the prognostic significance of peripheral monocytosis after AMI remains to be determined. METHODS: A total of 149 patients with first Q-wave AMI were studied. White blood cell (WBC) count, percentage of monocytes and serum C-reactive protein level were measured every 24 h for four days after the onset of AMI. We assessed association between peripheral monocytosis and prognosis including pump failure, LV aneurysm and long-term outcome after AMI. RESULTS: Patients with pump failure (p < 0.0001) or LV aneurysm (p = 0.005) had higher peak monocyte counts than those without these complications. Predischarge left ventriculography revealed that peak monocyte count was positively correlated with LV end-diastolic volume (p = 0.024) and negatively correlated with ejection fraction (p = 0.023). Multivariate analyses showed that peak monocyte count > or = 900/mm(3) was an independent determinant of pump failure (relative risk [RR] 9.83, p < 0.0001), LV aneurysm (RR 4.78, p = 0.046) and cardiac events (RR 6.30, p < 0.0001), including readmission for heart failure, recurrent myocardial infarction and cardiac deaths, including sudden deaths. CONCLUSIONS: Peripheral monocytosis is associated with LV dysfunction and LV aneurysm, suggesting a possible role of monocytes in the development of LV remodeling after reperfused AMI.
Asunto(s)
Leucocitos Mononucleares/fisiología , Infarto del Miocardio/sangre , Infarto del Miocardio/fisiopatología , Remodelación Ventricular , Adulto , Anciano , Anciano de 80 o más Años , Angioplastia Coronaria con Balón , Proteína C-Reactiva/análisis , Angiografía Coronaria , Creatina Quinasa/sangre , Femenino , Aneurisma Cardíaco/sangre , Aneurisma Cardíaco/fisiopatología , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/terapia , Pronóstico , Modelos de Riesgos ProporcionalesRESUMEN
BACKGROUND: We sought to investigate the arrhythmogenic role, incidence, treatment, and prognosis of inflammatory left ventricular (LV) microaneurysms in patients with apparently idiopathic ventricular tachyarrhythmias. Methods and Results-- We studied 156 consecutive patients (71 men, 85 women; mean age, 44.1+/-11.8 years) with severe ventricular arrhythmias and normal 2D echo cardiac parameters by coronary and ventricular angiography, biventricular endomyocardial biopsy, and electrophysiological study. Polymerase chain reaction was used to detect genomic sequences of enterovirus, adenovirus, Epstein Barr virus, cytomegalovirus, herpes simplex viruses, influenza A and B viruses, and hepatitis C virus in frozen endomyocardial samples. Of these patients, 15 (9.6%) showed angiographic evidence of single or multiple LV microaneurysms. All 15 patients had recurrent episodes of ventricular tachycardia with right bundle-branch block morphology, and the arrhythmias originated within or close to the aneurysms in those patients (n=6) undergoing ventricular mapping. A lymphocytic myocarditis was observed in LV biopsies of all patients and in the right ventricles of 3 patients. Polymerase chain reaction analysis was performed in 12 and viral genomes were found in 5 (42%): hepatitis C virus in 2, enterovirus in 2, and influenza virus A in 1. The patients were treated with antiarrhythmics, and cardiac function was preserved for the next 47+/-39.5 months of follow-up. No major clinical event was registered, and arrhythmias were successfully treated by antiarrhythmics. CONCLUSIONS: Inflammatory LV microaneurysms, often of viral origin, are a consistent cause of apparently idiopathic ventricular arrhythmias. Their prognosis so far has been benign, and aggressive therapeutic strategies have been unnecessary.
Asunto(s)
Aneurisma Cardíaco/complicaciones , Miocarditis/complicaciones , Taquicardia Ventricular/etiología , Virosis/complicaciones , Virosis/diagnóstico , Adolescente , Adulto , Antiarrítmicos/uso terapéutico , Anticuerpos Antivirales/sangre , Biopsia , Bloqueo de Rama/complicaciones , Bloqueo de Rama/diagnóstico , Angiografía Coronaria , Ecocardiografía , Electrocardiografía Ambulatoria , Técnicas Electrofisiológicas Cardíacas , Femenino , Aneurisma Cardíaco/sangre , Aneurisma Cardíaco/diagnóstico , Ventrículos Cardíacos/patología , Ventrículos Cardíacos/virología , Humanos , Masculino , Persona de Mediana Edad , Miocarditis/sangre , Miocarditis/patología , Reacción en Cadena de la Polimerasa , Pronóstico , ARN Viral/aislamiento & purificación , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/tratamiento farmacológicoRESUMEN
Cardiac impairment in patients is associated with intracardiac thrombus formation and thromboembolism. A high prothrombotic state may exist in such patients, and abnormalities in plasma markers of thrombogenesis may be indicative of such a state. The aim of this study was to determine the associations of left ventricular (LV) aneurysm formation and dysfunction with plasma fibrinogen, von Willebrand factor, and fibrin D-dimer, which are markers associated with thrombus formation (thrombogenesis) and to investigate the effects of warfarin given to patients with LV aneurysms on fibrinogen and D-dimer levels. A cross-sectional study of 112 patients with coronary artery disease was initially performed: 34 patients had normal LV function (group 1); 30 had LV dysfunction without aneurysm formation (group 2); 29 had LV aneurysms without anticoagulation (group 3a); and 19 patients had LV aneurysms with warfarin therapy (group 3b). Results were compared with 158 population controls from a random population sample. A longitudinal study of 10 patients given warfarin was also performed. In group 1, plasma fibrinogen (median difference 0.36 g/L; p = 0.0009) and von Willebrand factor (median difference 17 IU/dl; p = 0.04) were elevated, whereas plasma D-dimer levels (median difference 23.0 ng/ml; p = 0.001) were lower than those in population control subjects. There were no significant differences in plasma fibrinogen, von Willebrand factor, or D-dimer levels between groups 1 and 2. In group 3a, plasma fibrinogen was elevated when compared with group 1 (median difference 0.6 g/L; p = 0.0001), with a trend toward high von Willebrand factor levels.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Enfermedad Coronaria/complicaciones , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Fibrinógeno/metabolismo , Aneurisma Cardíaco/tratamiento farmacológico , Disfunción Ventricular Izquierda/tratamiento farmacológico , Warfarina/uso terapéutico , Factor de von Willebrand/metabolismo , Análisis de Varianza , Enfermedad Coronaria/sangre , Estudios Transversales , Femenino , Aneurisma Cardíaco/sangre , Aneurisma Cardíaco/etiología , Ventrículos Cardíacos , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Tromboembolia/etiología , Tromboembolia/prevención & control , Disfunción Ventricular Izquierda/sangre , Disfunción Ventricular Izquierda/etiologíaRESUMEN
Clinical data on the contributory role of heart failure to thromboembolic risk does not differentiate between systolic and diastolic left ventricular dysfunction. We therefore conducted a population-controlled cross-sectional study to determine levels of plasma fibrinogen (associated with thromboembolism), fibrin D-dimer (a marker of fibrin turnover) and von Willebrand factor (a marker of endothelial dysfunction) in patients with ischaemic heart disease (a common cause of diastolic dysfunction) in whom left ventricular diastolic function was defined by echocardiography. We studied 106 patients: those with normal left ventricular function (n = 42, Group 1); those with left ventricular dysfunction but without aneurysms (n = 34, Group 2); and those with left ventricular aneurysm formation (n = 30, Group 3). Each of these groups was subdivided into those with (a) and without (b) diastolic dysfunction. Diastolic dysfunction was present in over 60% of patients, irrespective of left ventricular systolic impairment. There were no significant differences in median levels of plasma fibrinogen, fibrin D-dimer or von Willebrand factor in each group of patients with ischaemic heart disease, whether or not left ventricular diastolic dysfunction was present (Mann-Whitney test; P = N.S.). Systolic (rather than diastolic) dysfunction was the main correlate of these (analysis of variance, general linear model--ANOVA-GLM--P < 0.05) and the greatest abnormalities of fibrinogen, endothelial dysfunction and intravascular fibrin turnover were seen in patients with left ventricular aneurysms whether or not diastolic dysfunction was present. This study demonstrates that there is no evidence of a significant additional contribution to thrombotic risk (as assessed by plasma fibrinogen, von Willebrand factor and fibrin D-dimer) for patients with left ventricular diastolic dysfunction. A relationship is noted between some prothrombotic factors and Doppler indices of flow, which suggests a possible association between cardiac haemodynamics and thrombogenesis.
Asunto(s)
Biomarcadores , Enfermedad Coronaria/complicaciones , Diástole , Tromboembolia/complicaciones , Análisis de Varianza , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Enfermedad Coronaria/sangre , Enfermedad Coronaria/diagnóstico por imagen , Estudios Transversales , Ecocardiografía Doppler de Pulso , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Fibrinógeno/metabolismo , Aneurisma Cardíaco/sangre , Aneurisma Cardíaco/complicaciones , Aneurisma Cardíaco/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Estudios Prospectivos , Sístole , Tromboembolia/sangre , Tromboembolia/diagnóstico por imagen , Factor de von Willebrand/metabolismoRESUMEN
A thirty-eight-year-old man with primary thrombocythemia, von Recklinghausen neurofibromatosis, and myocardial-infarction-related left ventricular aneurysm with spontaneous echocardiographic contrast was followed up, suggesting that: 1. Neurofibromatosis may promote silent myocardial infarction or ischemia. Whether involvement of cardiac sensory nerves is a possible underlying mechanism remains nevertheless uncertain. 2. Platelets, whose role in the genesis of spontaneous echocardiographic contrast has been advocated, are probably not involved in this phenomenon, even in large numbers.
Asunto(s)
Ecocardiografía , Aneurisma Cardíaco/diagnóstico por imagen , Neurofibromatosis 1/diagnóstico por imagen , Trombocitemia Esencial/diagnóstico por imagen , Trombocitosis/diagnóstico por imagen , Adulto , Electrocardiografía , Aneurisma Cardíaco/sangre , Aneurisma Cardíaco/etiología , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Infarto del Miocardio/sangre , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico por imagen , Neurofibromatosis 1/sangre , Agregación Plaquetaria , Recuento de Plaquetas , Trombocitemia Esencial/sangre , Trombocitosis/sangreRESUMEN
The experiment on 39 dogs has shown that in MI the concentration dynamics of conjugates in the blood plasma is in accordance with the forms of its healing and has two periods of activation related, respectively, to necrotic processes and development of granular tissue in the infarction zone. The control over the changes of peroxide lipid oxidation (PLO) in MI may be regarded as one of the methods of diagnosing and foreseeing the outcomes of its healing. In optimization of MI healing, to modulate PLO appears to be advisable, that is, to make its course typical of noncomplicated MI.
Asunto(s)
Peróxidos Lipídicos/sangre , Infarto del Miocardio/sangre , Aminopirina/farmacología , Animales , Perros , Aneurisma Cardíaco/sangre , Aneurisma Cardíaco/etiología , Peroxidación de Lípido/efectos de los fármacos , Lipopolisacáridos/farmacología , Infarto del Miocardio/complicaciones , Infarto del Miocardio/etiología , Factores de TiempoRESUMEN
In 16 patients with acute myocardial infarction and in 15 controls, procollagen type III aminoterminal peptide in serum (PIIINP) was measured consecutively. Serum PIIINP was increased on the second to third postinfarction day (p less than 0.01) and remained elevated for more than 4 months. Peak values were observed on the third to seventh postinfarction day. The individual peak changes were correlated to infarction size calculated from serum CK-MB and serum lactate dehydrogenase (p = 0.60, p = 0.02). The changes in distribution of PIIINP-related antigens in serum after gel chromatography were similar to changes observed during wound healing in humans. PIIINP is cleaved off procollagen type III during the biosynthesis of type III collagen, which characterizes the early stages of repair and inflammation. Our findings suggest that serum PIIINP reflects the repair processes and scar formation following acute myocardial infarction. The serum PIIINP alterations in acute myocardial infarction differ essentially from the changes in myocardial enzymes reflecting myocardial injury. Serum PIIINP may therefore provide new and clinically relevant information on the healing of myocardial infarction.
Asunto(s)
Infarto del Miocardio/sangre , Fragmentos de Péptidos/sangre , Procolágeno/sangre , Cicatrización de Heridas , Adulto , Anciano , Anciano de 80 o más Años , Cromatografía en Gel , Femenino , Aneurisma Cardíaco/sangre , Tabiques Cardíacos , Ventrículos Cardíacos , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Plasma levels of human atrial natriuretic peptide were determined during different stages of a symptom-limited bicycle ergometer stress test. Eight healthy persons and three patients suffering from well-defined cardiac disorders were examined. Measurements of the peptide were performed before the exercise, at 75 watts, at maximal work load, and 10 and 30 min after ceasing the exercise. In healthy persons plasma levels of the peptide increased from preexercise levels of 4-41 ng/l to 16-59 ng/l at maximal work load, but remained in the normal range (10-70 ng/l). In contrast, in the cardiac patients, levels of the peptide were up to 8-fold higher at maximal physical exertion (154-270 ng/l) than at rest (34-86 ng/l). Within a recovery period of 30 min hormone concentrations returned almost to preexercise levels.