Recent valves used for transluminal implantation in patients with aortic valve stenosis.

Aortic valve stenosis is becoming a burden to society due to the constantly aging population. After the onset of the first symptoms it usually follows an ominous route with high mortality levels even at two years without any medical intervention. The gold standard for treating aortic valve stenosis is surgical replacement; nonetheless, 30% of patients are left untreated due to increased risk of surgery. A less invasive method has been developed in the past decade, transcatheter aortic valve implantation (TAVI), which allows implantation of prosthesis in the native stenosed aortic valve position, using a catheter that enters the body in a transvascular way or through a minimal surgical cut down. In this review, we briefly discuss where the TAVI field begun, focus on the recent valves that are being used and finally look at what lies ahead. The review of the patents will assist in the understanding of how this field evolved, how it became established and what is to be expected in the future.

The effects of angiotensin receptor blockers vs. calcium channel blockers on the acute exercise-induced inflammatory and thrombotic response.

Arterial hypertension is an established risk factor for acute coronary syndromes, and physical exertion may trigger the onset of such an event. The mechanisms involved include the rupture of a small, inflamed, coronary plaque and the activation of thrombogenic factors. Blood pressure (BP)-lowering treatment has been associated with beneficial effects on subclinical inflammation and thrombosis at rest and during exercise. This prospective study sought to compare the effect of different antihypertensive drugs on the inflammatory and thrombotic response during exercise. A total of 60 never-treated hypertensive patients were randomized to an angiotensin receptor blocker (ARB)- or non-dihydropyridine calcium channel blocker (CCB)-based regimen. Patients with inflammatory or coronary artery disease were excluded. Six months after pharmaceutical BP normalization, the patients underwent a maximal treadmill exercise testing. High-sensitivity C-reactive protein (hsCRP), serum amyloid A (SAA), white blood cells (WBC), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), total fibrinogen (TF) and von Willebrand factor (vWF) levels, as well as plasminogen activator inhibitor-1 (PAI-1) activity were measured in blood samples taken while the patients were at rest and during peak exercise. All of these biomarkers increased with exercise, except PAI-1, which decreased (P<0.05 for the difference between resting and peak exercise for all biomarkers). The ARB group had less marked (P<0.05) exercise-induced changes than the CCB group in hsCRP (5.8% vs. 7.7%), SAA (4.2% vs. 7.2%), WBC (46.8% vs. 52.6%), TNF-α (16.3% vs. 24.3%), TF (9.5% vs. 16.9%) and PAI-1 (-9.5% vs. -12.3%) but a similar (P=NS) change in IL-6 (39.4% vs. 38.6%) and vWF (29.2% vs. 28.6%). In conclusion, ARBs are most likely more effective than CCBs at suppressing the exercise-induced acute phase response. Potential protection against exercise-related coronary events remains to be elucidated.

P wave analysis indices in young healthy men: data from the digital electrocardiographic study in Hellenic Air Force Servicemen (DEHAS).

P wave analysis from the 12-lead ECG is a recent contribution of noninvasive electrocardiology. P wave analysis indices (maximum and minimum P wave duration, P wave dispersion [Pdis = Pmax-Pmin], adjusted P wave dispersion [APdis = Pdis/square root of measured leads], summated P wave duration [Psum], standard deviation of P wave duration [Psd], mean P wave duration [Pmean]) can predict atrial arrhythmias. However, the definitions of all these indices are based on few studies. The aim of this analysis was to define normal values of these indices and the examine possible associations between P wave indices and clinical variables. The study included 1,353 healthy men, 24 +/- 3 years of age, who answered a questionnaire and underwent a detailed physical examination and a digitized 12-lead surface ECG. All P wave indices were analyzed by two independent investigators. Mean values of the ECG indices were: Pmax: 96 +/- 11 ms, Pmin: 57 +/- 9 ms, Pdis: 38 +/- 10 ms, Psum: 924 +/- 96 ms, Psd: 12 +/- 3, APdis: 11 +/- 3 ms, and Pmean: 77 +/- 8 ms. Age was significantly related with Pmax (r = 0.277, P < 0.01), Pmin (r = 0.255, P < 0.001), Psum (r = 0.074, P < 0.01), and Pmean (r = 0.074, P < 0.01). All ECG indices were significantly associated with the R-R interval, and among each other. This study defined normal indices of wave duration and correlations among them. These markers may play an important predictive role in patients with atrial conduction abnormalities.

Parallel morning and evening surge in stroke onset, blood pressure, and physical activity.

BACKGROUND AND PURPOSE: A circadian variation with a morning peak on waking and arising is known to occur in both blood pressure (BP) and cardiovascular event onset. A second peak in BP has been described to occur after an afternoon sleep (siesta). This study was designed to investigate the hypothesis that the 2-peak diurnal variation of BP is dependent on physical activity and occurs in parallel with the diurnal variation of stroke onset. METHODS: The diurnal variation of stroke onset was compared with the diurnal variation of BP, pulse rate (PR), and physical activity in 3 independent groups of Greek hypertensives 51 to 80 years of age (633 stroke patients, 379 subjects with 24-hour ambulatory BP monitoring, and 50 subjects with 24-hour physical activity monitoring through wrist devices). RESULTS: The diurnal variation of stroke onset, BP, and PR all showed 1 morning and 1 evening peak with a decline in the afternoon and at night that occurred in parallel with the diurnal variation in physical activity (P<0.001 for differences among morning, afternoon, evening, and nighttime intervals in BP, PR, activity, and stroke). The afternoon decline in BP, PR, and activity was significant only in subjects with a siesta. CONCLUSIONS: The 2-peak diurnal variation in stroke onset occurred in parallel with the variation in BP, PR, and physical activity. These data support the hypothesis that an abrupt change in physical activity is not only a major determinant of the 2-peak diurnal variation of BP but also an important triggering factor for a cerebrovascular event.