Inflammatory responses after percutaneous coronary intervention in patients with acute myocardial infarction or stable angina pectoris.

OBJECTIVE: To investigate the profile of circulating inflammatory markers after percutaneous coronary intervention (PCI) in patients with AMI or stable angina pectoris (AP). MATERIAL AND METHODS: Twenty patients with AMI and 10 with stable AP were treated with PCI of a central coronary artery. Blood samples were drawn immediately before PCI, in the AP group and after 3 and 12 h, days 1, 3, 5, 7 and 14 in both groups. RESULTS: Interleukin 6 increased in both groups to time-point 12 h and day 1 (peak), being significantly higher in the AMI group compared to the AP group at 3 and 12 h, and also at days 1 and 3. A similar profile was demonstrated for CRP with significantly higher levels in the AMI group at days 1, 3 and 5 compared to the AP group. A slightly different pattern was shown for Interleukin 10 (IL-10) with significantly higher levels in the AMI group at 3 and 12 h, days 1 and 14 compared to the AP group. CONCLUSION: AMI patients treated with PCI experienced a marked short-term increase in pro-inflammatory mediators as well as IL-10 compared to patients with stable angina pectoris treated with PCI.

Myocardial distribution and regulation of GRK and beta-arrestin isoforms in congestive heart failure in rats.

Myocardial G protein-coupled receptor kinase 2 (GRK2) has been shown to be involved in the pathophysiology of congestive heart failure (CHF). However, the cellular distribution of this isoform, as well as the other isoforms of the GRK-arrestin system, has not been studied in myocardial tissue. Thus myocardial expression and cellular distribution of the different GRK and arrestin isoforms were investigated in a rat model of CHF. Rats subjected to ligation of the left coronary artery or sham operation were euthanized 2, 7, or 42 days after the surgical procedure. Myocardial GRK2, GRK5, beta-arrestin-1, and beta-arrestin-2 mRNA levels, but not that of GRK3, were induced in the failing hearts. Consistently, Western blot analysis of tissue extracts from the nonischemic region of the left ventricle revealed 3.0-, 2.6-, and 1.5-fold elevations of GRK2, GRK5, and beta-arrestin-1, respectively, 7 days after induction of myocardial infarction compared with the sham-operated rats (P < 0.05). Immunohistochemical analysis of myocardial tissue sections and Western blot analysis of isolated cells revealed localization of GRK2 and beta-arrestin-1 predominantly in endothelial cells. Conversely, GRK3 was confined to cardiac myocytes. GRK5 immunostaining appeared to be homogeneously distributed in the cellular elements of the myocardium. In conclusion, myocardial mRNA and protein levels of GRK2, GRK5, and beta-arrestin-1 are induced in postinfarction failure in rats. The immunohistochemical analysis suggests that GRK2 and beta-arrestin-1 may act as primary regulators of endothelial function. Conversely, the cellular distribution of GRK3 and GRK5 implicates these isoforms as putative regulators of cardiac myocyte function.

Induction of a myocardial adrenomedullin signaling system during ischemic heart failure in rats.

BACKGROUND: Increased plasma adrenomedullin (ADM) levels have been reported in congestive heart failure (HF). The present study was designed to investigate myocardial regulation of the different components of the ADM signaling system (ADM, ADM receptor, and receptor-activity-modifying protein-2, RAMP-2) during ischemic HF in rats and to identify the cells in the myocardium displaying ADM-like immunoreactivity (ADM-ir). Furthermore, the effects of endothelin (ET) receptor antagonism on expression of the myocardial ADM system during HF were investigated. METHODS AND RESULTS: Northern blot analysis revealed increased ADM mRNA expression in the nonischemic left ventricle, with maximal levels 28 days after induction of myocardial infarction (1.5-fold, P<0.05) compared with the sham group. Parallel elevations of myocardial ADM receptor and RAMP-2 mRNA levels were also observed (2.3- and 1.5-fold increase, respectively; P<0.05). In addition, high levels of ADM mRNA were seen in the ischemic region. Immunohistochemical analysis revealed a substantial increase of ADM-ir in microvascular endothelium and perivascular interstitial cells of myocardial tissue contiguous to the ischemic region. In addition, radioligand binding studies demonstrated a 1.6-fold increase of specific ADM binding sites in the failing left ventricle (P<0.05). Intervention with the mixed ET(A)/ET(B) receptor antagonist bosentan (100 mg. kg(-1). day(-1) PO) for 15 days prevented the increase of RAMP-2 mRNA. CONCLUSIONS: The study demonstrates a concerted induction of several components of the myocardial ADM signaling system during postinfarction failure and that the vessels are the main source of myocardial ADM. Our observations indicate a role for ADM as an autocrine/paracrine factor during ventricular remodeling after myocardial infarction.

[Should oral contraceptives and postmenopausal hormonal substitution be withdrawn prior to surgery? A questionnaire study in departments of surgery and gynecology]. / Skal peroral antikonsepsjon og postmenopausal hormonsubstitusjon seponeres før operasjon? Spørreundersøkelse blant kirurgiske og gynekologiske avdelinger.

We conducted a survey among the surgical and gynaecological departments of all Norwegian hospitals, about today's practice concerning oral contraceptives and surgery. Most of the surgical and gynaecological departments recommend discontinuance of the pill two and four weeks prior to surgery, and reintroduction upon mobilisation postoperatively. In surgical emergencies amongst women who use the pill, 4/5 surgical and 2/3 gynaecological departments would prefer to give thrombosis prophylaxis. Low molecular weight heparin was recommended most. Surgical departments especially recommend stopping the use of the progestogene only contraceptive pill, and post menopausal oestrogen substitution, before elective surgery. Both gynaecological and surgical departments give inadequate information about the use of alternative birth control during the period when the pill is not taken. The survey did not show any difference between university and central/county hospitals.