Effects of gold coating of coronary stents on neointimal proliferation following stent implantation.

Experimental studies suggest a reduced neointimal tissue proliferation in vascular stainless steel stents coated with gold. This prospective multicenter trial evaluated the impact of gold coating on neointimal tissue proliferation in patients undergoing elective stent implantation. The primary end point was the in-stent tissue proliferation measured by intravascular ultrasound at 6 months comparing stents of identical design with or without gold coating (Inflow). Two hundred four patients were randomized to receive uncoated (group A, n = 101) or coated (group B, n = 103) stents. Baseline parameters did not differ between the groups. Stent length and balloon size were comparable, whereas inflation pressure was slightly higher in group A (14 +/- 3 vs 13 +/- 3 atm, p = 0.013). Procedural success was similar (A, 97%; B, 96%). The acute angiographic result was better for group B (remaining stenosis 4 +/- 12% vs 10 +/- 11%, p = 0.002). Six-month examinations revealed more neointimal proliferation in group B. By ultrasound, the neointimal volume within the stent was 47 +/- 25 versus 41 +/- 23 mm(3) (p = 0.04), with a ratio of neointimal volume-to-stent volume of 0.45 +/- 0.12 versus 0.40 +/- 0.12 (p = 0.003). The angiographic minimal luminal diameter was smaller in group B (1.47 +/- 0.57 vs 1.69 +/- 0.70 mm, p = 0.04), with a higher late luminal loss of 1.17 +/- 0.51 versus 0.82 +/- 0.56 mm (p = 0.001). Thus, gold coating of the tested stent type resulted in more neointimal tissue proliferation.

Myocardial hypertrophy and enhanced left ventricular contractility in Zucker diabetic fatty rats.

Heart failure is known to be a complication of insulin-dependent (IDDM) and noninsulin-dependent diabetes mellitus (NIDDM) even in the absence of coronary heart disease or hypertension. The mechanisms leading to diabetic cardiomyopathy are unknown. The aim of the study was to characterize structural and functional alterations in hyperinsulinemic Zucker diabetic fatty (ZDF) rats treated with or without insulin. Diabetic animals showed a twofold increase in cardiomyocyte volume with increased left ventricular ANP but not BNP mRNA levels in spite of a reduced plasma renin activity (PRA) 2 months after onset of diabetes compared to nondiabetic littermates. These changes were associated with an increase in left ventricular performance as assessed by echocardiography. Insulin treatment led to a significant increase in body weight (BW), total heart weight, myocardial protein content, and left ventricular mass (LVM). Perivascular fibrosis and laminin thickness were significantly augmented in diabetic rat myocardium irrespective of insulin treatment, whereas interstitial collagen I and fibronectin were similarly found in diabetic and control myocardium. Initial stages of diabetic cardiomyopathy in hyperinsulinemic rats are characterized by cardiomyocyte hypertrophy and enhanced cardiac contractility. It is suggested that hyperinsulinemia may be involved in cardiac hypertrophy.

Experimental diabetes and left ventricular hypertrophy: effects of beta-receptor blockade.

BACKGROUND: Left ventricular hypertrophy involves growth of cardiomyocytes, as well as remodeling of extracellular matrix proteins (ECMPs). Several metabolic abnormalities may be triggered secondary to hyperglycemia in diabetes. The effects of combined supravalvular aortic banding and diabetes mellitus on the rat heart were investigated in order to detect possible synergistic effects of these two conditions. Moreover, this study focused on the impact of beta-adrenoceptor blockade with carvedilol (C) on the expression of ECMPs. METHODS: Sixty male Wistar rats were allocated to six groups: control (CON), CON+C, streptozotocin (65 mg/kg iv)-induced diabetes (D), D+C, aortic stenosis (AS)+D and AS+D+C. Follow-up was 6 weeks. RESULTS: Relative left ventricular weight was elevated and body weight was decreased in D, AS+D and AS+D+C rats (P<.05 vs. CON). Diabetes elevated cardiomyocyte widths, perivascular/interstitial fibrosis (P<.01 each), as well as ECMPs: collagen I/fibronectin/laminin were 3.4-fold/4.1-fold/1.5-fold elevated in D rats and further increased (4.6-fold/5.9-fold/1.9-fold) in AS+D rats (P<.01 vs. CON). Heart rate and blood pressure decreased in D and AS+D rats (P<.05 vs. CON). Carvedilol application attenuated the overexpression of ECMPs. CONCLUSIONS: Beta-adrenoceptor blockade results in regression of the hypertrophic phenotype and in decrease of ECMP in rats with experimental diabetes and in animals with combined chronic pressure overload and hyperglycemia. These results represent a new mechanism of carvedilol that may contribute to the observed beneficial effects in heart failure.

Effects of aortic stenosis on renal renin, angiotensin receptor, endothelin and NOS gene expression in rats.

BACKGROUND/AIMS: Published data regarding the effects of common cardiovascular diseases, i.e. aortic stenosis on renal regulation of major vasoconstrictive (renin, endothelins) and vasodilatory systems (NO) are controversial. Therefore we aimed to evaluate the effects of chronic aortic stenosis on the renal renin-angiotensin, endothelin and NO systems. METHODS: Experimental supravalvular aortic stenosis was induced by using silver clips with a 0.6 mm internal diameter on the ascending aorta of weanling rats. Renal endothelin-1 (ET-1), endothelin-3 (ET-3), renin, AT(1a), AT(1b), eNOS, and bNOS gene expression were assessed by RNase protection assay. RESULTS: Renal renin gene expression increased twofold in rats with aortic stenosis. In contrast, renal ET-1, ET-3, eNOS, bNOS, and AT(1a), AT(1b) gene expression were unchanged in rats with aortic stenosis. CONCLUSION: Our study demonstrates that in rats with severe experimental supravalvular aortic stenosis only renal renin gene expression is stimulated. This contrasts with severe heart failure where endothelins and NO synthases are also upregulated. Different patterns of regulation of renal vasoactive mediators may be of importance for the extent of the renal impairment associated with aortic stenosis, and may be correlated with the severity of congestive heart failure.