Assessment of the Relationship Between Serum Vascular Adhesion Protein-1 (VAP-1) and Severity of Calcific Aortic Valve Stenosis.

BACKGROUND: Vascular adhesion protein-1 (VAP-1), a dual-function glycoprotein, is secreted by endothelial cells, adipocytes, and kidney and vascular smooth muscle cells. It has been reported to participate in the development of atherosclerosis as an adhesion molecule and a pro-inflammatory enzyme. Increased VAP-1 levels are related to type 2 diabetes mellitus, atherosclerosis, stroke and chronic renal failure. The study aim was to investigate serum VAP-1 levels in patients with calcific aortic stenosis (AS) and the possible relationship between VAP-1 and severity of calcific AS. METHODS: A total of 168 patients was categorized as having mild (n = 54), moderate (n = 58), or severe (n = 56) AS. Serum VAP-1 levels were measured using an enzyme-linked immunosorbent assay. RESULTS: The mean serum VAP-1 level was significantly higher in patients with AS compared to healthy controls (244.3 ± 50.1 ng/ml versus 149.8 ± 27.5 ng/ml, p <0.001), and in the severe AS group compared to the moderate and mild AS groups (288.3 ± 30.1 ng/ml, 243.1 ± 31.8 ng/ml, and 200.8 ± 43.2 ng/ml, respectively, p <0.001). The VAP-1 level was positively related to the maximum aortic gradient, mean aortic gradient, and maximum aortic jet velocity (r = 0.649, p <0.001; r = 0.660, p <0.001; r = 0.655, p <0.001, respectively) and negatively related to the aortic valve area (r = -0.683, p <0.001). CONCLUSIONS: The present study was the first to demonstrate a significant relationship between increased serum VAP-1 levels and the severity of calcific AS. VAP-1 might be a useful biomarker for the evaluation of AS and the follow up of its severity.

Comparison of periprocedural and long term outcomes of proximal versus distal cerebral protection method during carotid artery stenting.

BACKGROUND: The aim of this study was to assess the periprocedural and one-year outcomes of two different cerebral protection systems used during carotid artery stenting (CAS). PATIENTS AND METHODS: We enrolled 90 consecutive patients with carotid artery stenosis who underwent CAS with a proximal flow blockage protection system (mean age 69.7 ± 8) or distal protection with a filter (mean age 70.8 ± 7). RESULTS: CAS was performed successively on 89 patients (99 %). Adverse events were defined as major stroke, minor stroke, transient ischemic attack (TIA), myocardial infarction, and death. Two strokes, one TIA, one death, and one myocardial infarction were observed in-hospital. There were no significant differences in safety or benefits between the proximal flow blockage embolic protection system (n = 45) and the distal filter protection system (n = 45) in terms of clinically apparent cerebral embolism, TIA, death, or myocardial infarction during the periprocedural stage or during the one-year follow-up period. CONCLUSIONS: Although it has been shown that the proximal flow blockage cerebral protection system decreases the risk of silent cerebral embolism, it has no advantage over the distal filter protection system in terms of adverse cerebrovascular or cardiac events during the periprocedural stage or during the long-term follow-up period.

Successful electrical cardioversion in a massive concentric hypertrophic cardiomyopathy with atrial fibrillation.

A 59-year-old man with a known history of nonobstructive hypertrophic cardiomyopathy and chronic atrial fibrillation was admitted to our clinic with weakness, palpitation, and exertional dyspnea. Electrocardiogram showed atrial fibrillation with high ventricular rate (120 beats per minute), intraventricular conduction delay, and left ventricular (LV) hypertrophy with ST-segment depression and inverted T waves. A transthoracic echocardiogram showed massive LV concentric hypertrophy. Although there was no gradient increase in the LV outflow tract, marked turbulent flow was seen in midventricular region by colored Doppler echocardiography. On the fourth day of admission, transesophageal echocardiography was done and showed no thrombus in the left atrium. Electrical cardioversion with 100 J was applied to the patient, and atrial fibrillation was returned to sinus rhythm. His control Doppler echocardiogram revealed peak systolic resting gradient of 54 mm Hg, with an increase to 84 mm Hg at Valsalva maneuver at the LV outflow. Cardiac magnetic resonance showed concentric LV hypertrophy with a 35-mm thickness in diastole, mild scar tissue in LV anterior wall midapical segments, and right ventricle wall thickness with a 10 mm in diastole. There was no bradycardia or tachycardia in 24-hour Holter and exercise electrocardiographic testing.