Noninvasive assessment of left ventricular function prior to and 6 months after renal transplantation.

BACKGROUND: The purpose of this study was to evaluate the effect of a successful kidney transplantation on left ventricular functional parameters that can be measured with gated-single photon emission computed tomography (gated-SPECT) myocardial perfusion scintigraphy in patients with end-stage renal disease. MATERIALS AND METHODS: Thirty-two consecutive patients (22 male) who had undergone a successful kidney transplantation in whom gated-SPECT myocardial perfusion scintigraphy was performed prior to and 6 months after surgery were included. Functional parameters, such as left ventricular ejection fraction (LVEF), wall motion, and wall thickening, were calculated with quantitative gated-SPECT. RESULTS: The mean LVEF improved significantly (P<.001) from 52% (SD+/-11) before to 63% (SD+/-10) after renal transplantation. This was attributable to a significant improvement in the end-systolic volume (P=.028). Wall motion and wall thickening improved in almost all myocardial segments. We found a significant correlation between the levels of urea and creatinine and the LVEF. However, correlations between an increase in the LVEF and the improvement in urea (P=.30) and creatinine (P=.26) levels were not significant, which is probably related to the number of patients studied. CONCLUSION: The systolic left ventricular dysfunction in terms of LVEF, wall motion, and wall thickening improves significantly 6 months after kidney transplantation in patients with end-stage kidney disease. Long-term follow-up is required to establish the prognostic value of these findings.

Testing cognitive function in elderly populations: the PROSPER study. PROspective Study of Pravastatin in the Elderly at Risk.

OBJECTIVES: For large scale follow up studies with non-demented patients in which cognition is an endpoint, there is a need for short, inexpensive, sensitive, and reliable neuropsychological tests that are suitable for repeated measurements. The commonly used Mini-Mental-State-Examination fulfils only the first two requirements. METHODS: In the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER), 5804 elderly subjects aged 70 to 82 years were examined using a learning test (memory), a coding test (general speed), and a short version of the Stroop test (attention). Data presented here were collected at dual baseline, before randomisation for active treatment. RESULTS: The tests proved to be reliable (with test/retest reliabilities ranging from acceptable (r=0.63) to high (r=0.88) and sensitive to detect small differences in subjects from different age categories. All tests showed significant practice effects: performance increased from the first measurement to the first follow up after two weeks. CONCLUSION: Normative data are provided that can be used for one time neuropsychological testing as well as for assessing individual and group change. Methods for analysing cognitive change are proposed.

Detection of malignant right coronary artery anomaly by multi-slice CT coronary angiography.

Coronary artery anomalies occur in 0.3-0.8% of the population and infer a high risk for sudden cardiac death in young adults. Diagnosis is usually established during coronary angiography, which is hampered by poor spatial visualization. Magnetic resonance imaging is an alternative, but it is not feasible in the presence of metal objects or claustrophobia. In this report, a 15-year-old boy experienced ventricular fibrillation and was successfully resuscitated. Cardiac catheterization was inconclusive, and pacemaker implantation prohibited the use of MR imaging. Multi-slice CT coronary angiography revealed a malignant anomalous right coronary artery.

Molecular genetics and gene expression in atherosclerosis.

Although molecular cardiology is a relative young discipline, the impact of the new techniques on diagnosis and therapy in cardiovascular disease are extensive. Our insight into pathophysiological mechanisms is rapidly expanding and is changing our understanding of cardiovascular disease radically and irrevocably. Molecular cardiology has many different aspects. In this paper the importance of molecular cardiology and genetics for every day clinical practice are briefly outlined. It is expected that in the genetic predisposition for atherosclerotic disease multiple genes are involved (genetics). The role of only a minority of genes involved in the atherosclerotic process is known. Far less is known about particular gene-gene and gene-environment interactions. In some families disease can be explained mostly by a single, major gene (monogenic), of which the lipid disorder Familial Hypercholesterolemia is an example. In other cases, one or several variations in minor genes (multigenic) contribute to an atherosclerotic predisposition, for instance the lipoprotein lipase gene. Although mutations in this gene influence lipoprotein levels, disease development is predominantly depending on environmental influences. Recently several additional genetic risk factors were identified including elevated levels of lipoprotein (a) [Lp(a)], the DD genotype of angiotensin converting enzyme (ACE), and elevated levels of homocysteine. This illustrates the complexity of genetics in relation to atherosclerosis and the difficulty to assign predictive values to separate genetic risk factors. Furthermore, little attention has been given to protective genes thus far, explaining why some high risk patients are protected from vascular disease. Genetics based treatment or elimination of the genetic risk factor requires complete understanding of the pathogenic molecular basis. Once this requirement is fulfilled, disease management can be strived for, provided that adequate medical management is available. Recent studies suggest that such treatment should be genotype specific, as the genetic makeup can determine the outcome of a pharmacological intervention (pharmacogenetics). Once the trigger for atherosclerosis has initiated disease development, various genes are activated or silenced and contribute to lesion progression. Every stage of lesion development depends on a different gene expression programme (genomics). In this review paper an introduction is provided into genetics, pharmacogenetics and gene expression with respect to atherosclerotic disease.

Catheter sizes for quantitative coronary arteriography.

In quantitative coronary arteriography (QCA), the outer diameter of the contrast catheter is used almost exclusively as the calibration device. Since the true outer diameter of these catheters are smaller than the French sizes listed by the manufacturer, it has been advocated to measure the actual sizes with a precision micrometer. However, this represents a significant effort in the organizations of the QCA Angiographic Core Laboratories and of the participating cardiac catheterization laboratories. In the Dutch REGRESS trial on regression/progression of coronary artery disease, we have measured a total of 2,104 catheters from four different manufacturers. In 2,048 of the 2,104 catheters the variabilities in the measurements were 0.02-0.03 mm, which represents an error of only 1% of the average catheter sizes. In the remaining 56 catheter measurements, the variability was 0.04 mm. From these data we may conclude that from now on the stated mean values can be used for calibration purposes. This has important practical consequences for running clinical trials and QCA Core Laboratory operations.