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1.
Biomed Res Int ; 2020: 8571062, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32025521

RESUMEN

Background: Asymptomatic atherosclerosis is a common entity even at young age. Studies have suggested a strong relationship between increased arterial stiffness and asymptomatic carotid atherosclerosis (ACA) in general population, particularly in those with high cardiovascular risk, but no data exist from a younger population free from recognized cardiovascular disease. Hypothesis. We hypothesized there is an association between ACA and aortic pulse wave velocity (PWVao) in middle-aged, apparently healthy, normotensive population to reveal increased cardiovascular risk. Methods: We examined the relationship between ACA and PWVao in 236 apparently healthy, asymptomatic, normotensive, middle-aged subjects (age 47 ± 8 years; 52% women). PWVao was measured with the oscillometric method (Arteriograph). ACA was assessed by carotid artery ultrasonography. Results: ACA was present in 51 subjects. Subjects with ACA were older (p < 0.009), more likely to be smokers (p < 0.009), more likely to be smokers (p < 0.009), more likely to be smokers (p < 0.009), more likely to be smokers (p < 0.009), more likely to be smokers (p < 0.009), more likely to be smokers (p < 0.009), more likely to be smokers (p < 0.009), more likely to be smokers (. Conclusions: PWVao measured by the Arteriograph proved to be an independent marker of ACA. Our study may reveal high CV risk, detected as increased PWVao, which according to our study is related in a very high probability to asymptomatic carotid atherosclerosis in apparently healthy, young, and middle-aged subjects.

2.
Orv Hetil ; 161(4): 151-160, 2020 Jan.
Artículo en Húngaro | MEDLINE | ID: mdl-31955583

RESUMEN

Introduction: The prevalence of overweight and obesity is increasing worldwide, which affects not only adults, but children and adolescents as well. Moreover, this condition may lead to several comorbidities, such as elevated or even high blood pressure. Aim: Aim of this study was to assess the prevalence of overweight- and obesity-related elevated and high blood pressure in a population aged 3-18 years in Hungary. Method: Between 2005 and 2018, altogether 8624 (boys = 4719) individuals were enrolled to this study. Normal weight, overweight and obese groups were created on the basis of body mass index. The diagnosis of elevated (systolic and/or diastolic blood pressure is between 90th and 95th percentile) and high blood pressure (systolic and/or diastolic blood pressure is over 95th percentile) was based on detailed examination (laboratory tests, abdominal ultrasonography, paediatric cardiology and 24-hours ambulatory blood pressure monitoring). Results: In this study, the prevalence of overweight and obesity was 23.5% overall, 26.4% in boys and 20% in girls. The prevalence of elevated blood pressure was 9.8% in overweight patients, while it was 4.6% in the obese group. The prevalence of high blood pressure was 8.3% (odds ratio: 1.1%, 95% CI) among overweight subjects, while it was 26.7% (odds ratio: 3.6, 95% CI) in the obese group. Conclusion: To the best of our knowledge, this is the first Hungarian population-based study on the prevalence of overweight- and obesity-related elevated and high blood pressure assessed in a large contemporary cohort of children and adolescents. The cardiovascular risk is increased in this patient group. Hence, it is essential to set up a proper primary prevention strategy. Orv Hetil. 2020; 161(4): 151-160.


Asunto(s)
Hipertensión/epidemiología , Obesidad Pediátrica/epidemiología , Adolescente , Niño , Preescolar , Femenino , Humanos , Hungría/epidemiología , Masculino , Prevalencia
3.
Lung ; 197(2): 189-197, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30820636

RESUMEN

INTRODUCTION: Soluble urokinase-type plasminogen activator receptor (suPAR) is upregulated by inflammation and plays a role in the pathogenesis of atherosclerosis. Chronic obstructive pulmonary disease (COPD) is associated with enhanced systemic inflammation and increased risk for atherosclerosis, however, studies analysing the circulating suPAR levels in COPD are contradictory. The aim of the study was to investigate plasma suPAR concentrations together with markers of arterial stiffness in COPD. MATERIALS AND METHODS: Twenty-four patients with COPD and 18 non-COPD, control subjects participated in the study. Plasma suPAR was measured, together with lung volumes, symptom burden, exacerbation history, markers of arterial stiffness and soluble inflammatory biomarkers, such as endothelin-1, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6). RESULTS: Plasma suPAR levels were higher in COPD (2.84 ± 0.67 ng/ml vs. 2.41 ± 0.57 ng/ml, p = 0.03) and were related to lung function measured with FEV1 (r = - 0.65, p < 0.01) and symptom burden determined with the modified Medical Research Council questionnaire (r = 0.55, p < 0.05). Plasma suPAR concentrations correlated with various measures of arterial stiffness in all subjects, but only with ejection duration in COPD (r = - 0.44, p = 0.03). CONCLUSIONS: Plasma suPAR levels are elevated in COPD and relate to arterial stiffness. Our results suggest that suPAR may be a potential link between COPD and atherosclerosis.


Asunto(s)
Enfermedades Cardiovasculares/sangre , Enfermedad Pulmonar Obstructiva Crónica/sangre , Receptores del Activador de Plasminógeno Tipo Uroquinasa/sangre , Rigidez Vascular , Anciano , Biomarcadores/sangre , Proteína C-Reactiva/análisis , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/fisiopatología , Estudios de Casos y Controles , Estudios Transversales , Endotelina-1/sangre , Femenino , Volumen Espiratorio Forzado , Humanos , Interleucina-6/sangre , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Índice de Severidad de la Enfermedad , Regulación hacia Arriba , Capacidad Vital
4.
In Vivo ; 32(6): 1555-1559, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30348716

RESUMEN

AIM: We aimed to investigate the effects of a single carbon dioxide (CO2) treatment on arterial stiffness by monitoring the changes of aortic pulse-wave velocity (PWV) and aortic augmentation index (AIXao), which are indicators of arterial stiffness. PATIENTS AND METHODS: PWV and AIXao were measured by an invasively validated oscillometric device. The measurements of stiffness parameters were performed before the CO2 treatment, and at 1, 4 and 8 h after the first treatment. RESULTS: Thirty-one patients were included. No significant changes were found in PWV. AIXao decreased significantly 1 h and 4 h after CO2 treatment compared to baseline values (p=0.034 and p<0.001). AIXao increased 8 h after the CO2 treatment, but remained significantly lower than baseline AIXao values (p=0.016). CONCLUSION: CO2 treatment is capable of reducing peripheral vascular resistance. We hypothesize that CO2 is not only a temporal vasodilator but is also capable of activating vasodilation pathways.


Asunto(s)
Dióxido de Carbono/administración & dosificación , Hipertensión/tratamiento farmacológico , Enfermedades Vasculares Periféricas/tratamiento farmacológico , Análisis de la Onda del Pulso , Administración Cutánea , Adulto , Anciano , Aorta/efectos de los fármacos , Aorta/fisiopatología , Presión Sanguínea/efectos de los fármacos , Femenino , Humanos , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Enfermedades Vasculares Periféricas/fisiopatología , Rigidez Vascular/efectos de los fármacos , Vasodilatación/efectos de los fármacos
5.
Ann Nutr Metab ; 72(4): 259-264, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29597205

RESUMEN

BACKGROUND/AIMS: The prevalence of overweight and obesity in children and adolescents is increasing worldwide, and this condition is a risk factor for cardiovascular mortality. The aim of this study was to assess the prevalence of overweight and obesity among the 3-18-year-old population in Szolnok City and the surrounding areas. METHODS: Anthropometric data from healthy, white individuals recruited from nursery, elementary, and secondary schools were used to assess the prevalence of obesity and overweight in Szolnok City and the surrounding area, Jász-Nagykun-Szolnok county, Hungary. Healthy subjects numbering 6,824 (54% boys) were included; overweight and obesity were defined according to the relevant guidelines. RESULTS: Overweight individuals constituted 13.4% of the population and 6.6% were obese. The total prevalence was higher in boys (21.6%) than in girls (18.1%). The peak of the prevalence was observed at age 10 in both sexes (boys 33%, girls 27%) followed by a gradual decrease, which was more significant in the case of girls. CONCLUSIONS: On the basis of the recent Hungarian data, we have not detected any changes in overweight and obesity in the age group 3-9 years and we have found a significant decrease in the age group 7-14 years. Prevention of overweight and obesity in early childhood is essential.


Asunto(s)
Sobrepeso/epidemiología , Obesidad Pediátrica/epidemiología , Adolescente , Índice de Masa Corporal , Niño , Preescolar , Femenino , Humanos , Hungría/epidemiología , Masculino , Prevalencia
6.
Orv Hetil ; 157(13): 483-7, 2016 Mar 27.
Artículo en Húngaro | MEDLINE | ID: mdl-26996894

RESUMEN

Cardiovascular diseases are the most common diseases worldwide. They are responsible for one third of global deaths and they are the leading cause of disability, too. The usage of different levels of prevention in combination with effective risk assessment improved these statistical data. Risk assessment based on classic risk factors has recently been supported with several new markers, such as asymmetric dimethylarginine, which is an endogenous competitive inhibitor of nitric oxide synthase. Elevated levels of asymmetric dimethylarginine have been reported in obese, smoker, hypercholesterolemic, hypertensive and diabetic patients. According to previous studies, asymmetric dimethylarginine is a suitable indicator of endothelial dysfunction, which is held to be the preceding condition before atherosclerosis. Several researches found positive correlation between higher levels of asymmetric dimethylarginine and coronary artery disease onset, or progression of existing coronary disease. According to a study involving 3000 patients, asymmetric dimethylarginine is an independent risk factor of cardiovascular mortality in patients with coronary artery disease. This article summarizes the role of asymmetric dimethylarginine in prediction of cardiovascular diseases, and underlines its importance in cardiovascular prevention.


Asunto(s)
Arginina/análogos & derivados , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/diagnóstico , Endotelio Vascular/fisiopatología , Óxido Nítrico Sintasa/antagonistas & inhibidores , Arginina/sangre , Arginina/metabolismo , Aterosclerosis/sangre , Aterosclerosis/diagnóstico , Aterosclerosis/fisiopatología , Biomarcadores/sangre , Enfermedades Cardiovasculares/fisiopatología , Enfermedades Cardiovasculares/prevención & control , Humanos , Valor Predictivo de las Pruebas , Medición de Riesgo , Factores de Riesgo
7.
Can J Physiol Pharmacol ; 93(9): 779-85, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26322806

RESUMEN

Recently, several vasoactive molecules have been found in pericardial fluid (PF). Thus, we hypothesized that in coronary artery disease due to ischemia or ischemia-reperfusion, the level of vasoconstrictors, mainly endothelin-1 (ET-1), increases in PF, which can increase the vasomotor tone of arteries. Experiments were performed using an isometric myograph. Vasomotor effects of PF from patients undergoing coronary artery bypass graft (PFCABG, n = 14) or valve replacement (PFVR, n = 7) surgery were examined in isolated rat carotid arteries (N = 14; n = 26). Vasomotor responses to KCl (40 or 60 mmol/L) were also tested. The selective endothelin A receptor antagonist BQ123 (10(-6) mol/L) was used to elucidate the role of ET-1. Both the first and the second additions of KCl elicited increases in the isometric force of the isolated arteries (KCl1, 6.1 ± 0.2 mN; KCl2, 6.5 ± 0.9 mN). PFCABG and PFVR elicited substantial increases in the isometric force of arteries (PFCABG, 3.1 ± 0.7 mN; PFVR, 3.0 ± 0.9 mN; p > 0.05). The presence of the selective endothelin A receptor blocker significantly reduced arterial contractions to PFCABG (before BQ123, 2.6 ± 0.5 mN vs. after BQ123, 0.8 ± 0.1 mN; p < 0.05). This study is the first to demonstrate that PFs of patients elicit substantial arterial constrictions, which is mediated primarily by ET-1. Interfering with the vasoconstrictor action of PF could be a potential therapeutic target to improve coronary blood flow in cardiac patients.


Asunto(s)
Arterias Carótidas/fisiología , Enfermedad de la Arteria Coronaria , Endotelina-1/fisiología , Líquido Pericárdico/química , Líquido Pericárdico/fisiología , Vasoconstricción/fisiología , Animales , Enfermedad de la Arteria Coronaria/cirugía , Antagonistas de los Receptores de Endotelina/farmacología , Endotelina-1/análisis , Humanos , Técnicas In Vitro , Masculino , Péptidos Cíclicos/farmacología , Cloruro de Potasio/farmacología , Ratas , Vasoconstricción/efectos de los fármacos
8.
PLoS One ; 10(8): e0135498, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26313940

RESUMEN

BACKGROUND: Pericardial fluid (PF) contains several biologically active substances, which may provide information regarding the cardiac conditions. Nitric oxide (NO) has been implicated in cardiac remodeling. We hypothesized that L-arginine (L-Arg) precursor of NO-synthase (NOS) and asymmetric dimethylarginine (ADMA), an inhibitor of NOS, are present in PF of cardiac patients and their altered levels may contribute to altered cardiac morphology. METHODS: L-Arg and ADMA concentrations in plasma and PF, and echocardiographic parameters of patients undergoing coronary artery bypass graft (CABG, n = 28) or valve replacement (VR, n = 25) were determined. RESULTS: We have found LV hypertrophy in 35.7% of CABG, and 80% of VR patients. In all groups, plasma and PF L-Arg levels were higher than that of ADMA. Plasma L-Arg level was higher in CABG than VR (75.7 ± 4.6 µmol/L vs. 58.1 ± 4.9 µmol/L, p = 0.011), whereas PF ADMA level was higher in VR than CABG (0.9 ± 0.0 µmol/L vs. 0.7 ± 0.0 µmol/L, p = 0.009). L-Arg/ADMA ratio was lower in the VR than CABG (VRplasma: 76.1 ± 6.6 vs. CABGplasma: 125.4 ± 10.7, p = 0.004; VRPF: 81.7 ± 4.8 vs. CABGPF: 110.4 ± 7.2, p = 0.009). There was a positive correlation between plasma L-Arg and ADMA in CABG (r = 0.539, p = 0.015); and plasma and PF L-Arg in CABG (r = 0.357, p = 0.031); and plasma and PF ADMA in VR (r = 0.529, p = 0.003); and PF L-Arg and ADMA in both CABG and VR (CABG: r = 0.468, p = 0.006; VR: r = 0.371, p = 0.034). The following echocardiographic parameters were higher in VR compared to CABG: interventricular septum (14.7 ± 0.5 mm vs. 11.9 ± 0.4 mm, p = 0.000); posterior wall thickness (12.6 ± 0.3 mm vs. 11.5 ± 0.2 mm, p = 0.000); left ventricular (LV) mass (318.6 ± 23.5 g vs. 234.6 ± 12.3 g, p = 0.007); right ventricular (RV) (33.9 ± 0.9 cm2 vs. 29.7 ± 0.7 cm2, p = 0.004); right atrial (18.6 ± 1.0 cm2 vs. 15.4 ± 0.6 cm2, p = 0.020); left atrial (19.8 ± 1.0 cm2 vs. 16.9 ± 0.6 cm2, p = 0.033) areas. There was a positive correlation between plasma ADMA and RV area (r = 0.453, p = 0.011); PF ADMA and end-diastolic (r = 0.434, p = 0.015) and systolic diameter of LV (r = 0.487, p = 0.007); and negative correlation between PF ADMA and LV ejection fraction (r = -0.445, p = 0.013) in VR. CONCLUSION: We suggest that elevated levels of ADMA in the PF of patients indicate upregulated RAS and reduced bioavailability of NO, which can contribute to the development of cardiac hypertrophy and remodeling.


Asunto(s)
Arginina/análogos & derivados , Arginina/metabolismo , Cardiomegalia/metabolismo , Líquido Pericárdico/metabolismo , Adulto , Arginina/sangre , Cardiomegalia/diagnóstico , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Miocardio/patología , Óxido Nítrico/metabolismo , Óxido Nítrico/fisiología , Óxido Nítrico Sintasa/antagonistas & inhibidores , Remodelación Ventricular
9.
Acta Cardiol ; 70(1): 59-65, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26137804

RESUMEN

OBJECTIVE: This study aimed to determine the effect of single-bout exercise on aortic stiffness parameters in young basketball players. METHOD AND RESULTS: A total of 108 young male subjects (mean age 14.2 ± 3.4 years) were enrolled into the study. Simultaneous measure- ment of aortic pulse wave velocity (PWVao) and augmentation index (Alxao) were performed with the oscillometric, occlusive device. Echocardiographic parameters of left ventricular systolic and diastolic function at rest were also measured in sportsmen. We did not find significant differences of resting PWVao in comparison with young sportsmen (S) and age-matched healthy volunteers (V): 5.82 ± 0.14 m/s vs 5.83 ± 0.12 m/s for S and V groups, respectively. The values of PWVao measured after dynamic exercise, isometric exercise, and rest were 8.0 ± 0.5 m/s, 5.86 ± 0.1 m/s and 5.82 ± 0.1 m/s, respectively. We confirmed that values after dynamic exercise are significantly different from those after isometric exercise (P < 0.01) and those after rest (P < 0.01). The Alxao values exhibited a considerable, but statistically non-significant, decrease during dynamic exercise in the three groups (11.7 ± 7% vs 3.8 ± 3% vs- 0.9 ± 0.9% for groups 1, 2, and 3, respectively). CONCLUSION: We applied a feasible, clinically useful method which allowed us to measure changes in aortic PWV and Alx during acute, single-bout exercise on the basketball court in young sportsmen.


Asunto(s)
Atletas , Ejercicio/fisiología , Ventrículos Cardíacos/diagnóstico por imagen , Deportes/fisiología , Rigidez Vascular/fisiología , Función Ventricular Izquierda/fisiología , Adolescente , Velocidad del Flujo Sanguíneo , Presión Sanguínea , Niño , Ecocardiografía , Humanos , Masculino , Análisis de la Onda del Pulso
11.
Adv Med Sci ; 59(2): 213-20, 2014 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-25323760

RESUMEN

PURPOSE: To explore the response pattern of plasma adipokine and ghrelin levels to coronary artery bypass graft (CABG) surgery in patients with (on-pump) and without (off-pump) cardiopulmonary bypass (CPB). MATERIAL/METHODS: Sixteen consecutive patients (age: 62 ± 10 years, male: 10) with obstructive coronary artery disease (CAD) who underwent elective CABG surgery with CPB and intraoperative GIK infusion were selected for on-pump group and 19 CAD patients (age: 63 ± 10 years, male: 16) were included in the off-pump group. Blood samples were taken before, during and after surgery. Intraoperative samples were withdrawn simultaneously for peripheral vein and sinus coronarius (SC). Plasma adipokine concentrations were measured by ELISA, those of ghrelin by RIA kits. RESULTS: In response to surgical intervention there was an early, transient fall in plasma levels of adiponectin (p<0.0001) and resistin (p=0.002) followed by an increase to approach their initial values. Plasma ghrelin also increased (p=0.045), this increase, however, was confined to the period of GIK supported CPB. Plasma insulin (p=0.003) and resistin (p=0.009) was significantly higher in the peripheral vein than in SC. The perioperative hormone profile of patients without CPB (off-pump) proved to be comparable to that of on-pump patients in spite of the insulin administration and greater oxidative and inflammatory stress. CONCLUSIONS: Adipose tissue-derived factors appear to mediate the metabolic and vascular changes that occur in patients with CABG surgery. Epicardial adipose tissue is unlikely to have major contribution to the development of CAD as adipokines are not elevated in SC independent of the mode of intervention.


Asunto(s)
Adipoquinas/sangre , Tejido Adiposo/efectos de los fármacos , Puente de Arteria Coronaria/efectos adversos , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Cuidados Intraoperatorios , Complicaciones Posoperatorias/prevención & control , Adipoquinas/metabolismo , Tejido Adiposo/metabolismo , Anciano , Puente de Arteria Coronaria Off-Pump/efectos adversos , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/cirugía , Femenino , Humanos , Hungría/epidemiología , Hipoglucemiantes/administración & dosificación , Infusiones Intravenosas , Insulina/administración & dosificación , Insulina/sangre , Insulina/metabolismo , Secreción de Insulina , Complicaciones Intraoperatorias/epidemiología , Complicaciones Intraoperatorias/prevención & control , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Riesgo
12.
Arch Med Sci ; 9(1): 40-6, 2013 Feb 21.
Artículo en Inglés | MEDLINE | ID: mdl-23515029

RESUMEN

INTRODUCTION: The appearance of post-operative cognitive dysfunction as a result of open heart surgery has been proven by several studies. Focal and/or sporadic neuron damage emerging in the central nervous system may not only appear as cognitive dysfunction, but might strongly influence features of physiological tremor. MATERIAL AND METHODS: We investigated 110 patients (age: 34-73 years; 76 male, 34 female; 51 coronary artery bypass grafting (CABG), 25 valve replacement, 25 combined open heart surgery, 9 off-pump CABG) before surgery and after open-heart surgery on the 3(rd) to 5(th) post-operative day. The assessment of the physiological tremor analysis was performed with our newly developed equipment based on the Analog Devices ADXL 320 JPC integrated accelerometer chip. Recordings were stored on a PC and spectral analysis was performed by fast Fourier transformation (FFT). We compared power integrals in the 1-4 Hz, 4-8 Hz and 8-12 Hz frequency ranges and these were statistically assessed by the Wilcoxon rank correlation test. RESULTS: We found significant changes in the power spectrum of physiological tremor. The spectrum in the 8-12 Hz range (neuronal oscillation) decreased and a shift was recognised to the lower spectrum (p < 0.01). The magnitude of the shift was not significantly higher for females than for males (p < 0.157). We found no significant difference between the shift and the cross-clamp or perfusion time (p < 0.6450). CONCLUSIONS: The assessment of physiological tremor by means of our novel, feasible method may provide a deeper insight into the mechanism of central nervous system damage associated with open heart surgery.

14.
J Hypertens ; 30(12): 2314-21, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22990356

RESUMEN

OBJECTIVE: The measurement of aortic pulse wave velocity (PWV(ao)) is an accepted marker in stratifying individual cardiovascular risk in adults. There is an increasing volume of evidence concerning impaired vascular function in different diseases in paediatric populations, but, unfortunately, only a few studies are available on the measurement of normal PWV(ao) values in children. The aim of our study was to determine the reference values of PWV(ao) in a large healthy population using a newly developed technique. METHODS: Three thousand, three hundred and seventy-four healthy individuals (1802 boys) aged 3-18 years were examined by an invasively validated, occlusive, oscillometric device. RESULTS: The mean PWV(ao) values increased from 5.5 ± 0.3 to 6.5 ± 0.3 m/s (P < 0.05) in boys and from 5.6 ± 0.3 to 6.4 ± 0.3 m/s (P < 0.05) in girls. The increase, however, was not constant, and the values exhibited a flat period between the ages of 3 and 8 years in both sexes. The first pronounced increase occurred at the age of 12.1 years in boys and 10.4 years in girls. Moreover, between the ages of 3 and 8 years, the brachial SBP and mean blood pressures increased continuously and gradually, whereas the PWV(ao) remained unchanged. By contrast, beyond the age of 9 years, blood pressure and aortic stiffness trends basically moved together. CONCLUSION: Our study provides the largest database to date concerning arterial stiffness in healthy children and adolescents between the ages of 3 and 18 years, and the technology adopted proved easy to use in large paediatric populations, even at a very young age.


Asunto(s)
Aorta/fisiología , Estado de Salud , Análisis de la Onda del Pulso/normas , Adolescente , Niño , Preescolar , Femenino , Salud , Encuestas Epidemiológicas , Humanos , Masculino , Variaciones Dependientes del Observador , Oscilometría , Valores de Referencia
15.
J Cardiothorac Surg ; 7: 23, 2012 Mar 13.
Artículo en Inglés | MEDLINE | ID: mdl-22414337

RESUMEN

Heparin-induced thrombocytopenia (HIT) is one of the most common immune-mediated adverse drug reactions, with frequencies as high as 2-3% for certain groups of post-cardiac surgery patients. We report on an 50-year-old woman with early post-operative thrombosis of the prosthetic mitral valve due to heparin-induced thrombocytopenia. Non-invasive imaging (two-dimensional transesophageal echocardiography; 2D-TEE) allowed the exact localisation of thrombotic masses and revealed the increase of the mean diastolic mitral gradient. The HIT diagnosis was proved by the clinical scoring system, and with the identification of heparin platelet factor 4-induced antibodies. After the withdrawal of LMWH therapy and the start of intravenous lepirudin treatment, the patient's medical condition improved continuously. Follow-up echocardiography showed a step-wise decrease in the severity of the mean diastolic mitral valve gradient and a complete resolution of thrombus formations. Perhaps we may remind ourselves that, whilst HIT is one of the most common immune-mediated adverse drug reactions for certain groups of post-cardiac surgery patients, it can be managed successfully. We would also stress the importance of serial 2D-TEE examinations in the early post-operative period.


Asunto(s)
Anticoagulantes/efectos adversos , Prótesis Valvulares Cardíacas/efectos adversos , Heparina/efectos adversos , Insuficiencia de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Trombocitopenia/inducido químicamente , Trombosis/etiología , Femenino , Humanos , Persona de Mediana Edad , Trombocitopenia/complicaciones , Factores de Tiempo
16.
Clin Cardiol ; 35(1): 26-31, 2012 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22083664

RESUMEN

BACKGROUND: Arterial stiffness parameters are commonly used to determine the development of atherosclerotic disease. The independent predictive value of aortic stiffness has been demonstrated for coronary events. HYPOTHESIS: The aim of our study was to compare regional and local arterial functional parameters measured by 2 different noninvasive methods in patients with verified coronary artery disease (CAD). We also compared and contrasted these stiffness parameters to the coronary SYNTAX score in patients who had undergone coronary angiography. METHODS: In this study, 125 CAD patients were involved, and similar noninvasive measurements were performed on 125 healthy subjects. The regional velocity of the aortic pulse wave (PWVao) was measured by a novel oscillometric device, and the common carotid artery was studied by a Doppler echo-tracking system to determine the local carotid pulse wave velocity (PWVcar). The augmentation index (AIx), which varies proportionately with the resistance of the small arteries, was recorded simultaneously. RESULTS: In the CAD group, the PWVao and aortic augmentation index (Alxao) values increased significantly (10.1 ± 2.3 m/sec and 34.2% ± 14.6%) compared to the control group (9.6 ± 1.5 m/sec and 30.9% ± 12%; P < 0.05). We observed similar significant increases in the local stiffness parameters (PWVcar and carotid augmentation index [Alxcar]) in patients with verified CAD. Further, we found a strong correlation for PWV and AIx values that were measured with the Arteriograph and those obtained using the echo-tracking method (r = 0.57, P < 0.001 for PWV; and r = 0.65, P < 0.001 for AIx values). CONCLUSIONS: Our results indicate that local and regional arterial stiffness parameters provide similar information on impaired arterial stiffening in patients with verified CAD.


Asunto(s)
Aorta/fisiopatología , Arterias Carótidas/fisiopatología , Enfermedad de la Arteria Coronaria/fisiopatología , Rigidez Vascular/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Velocidad del Flujo Sanguíneo , Angiografía Coronaria , Ecocardiografía Doppler , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oscilometría , Valor Predictivo de las Pruebas , Flujo Pulsátil
17.
Coron Artery Dis ; 22(4): 245-52, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21383621

RESUMEN

OBJECTIVES: We measured and compared serum asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), and L-arginine levels in patients undergoing coronary artery revascularization. METHODS: Two groups of patients with coronary artery disease were subjected to coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CPB; n = 20) or with off-pump CABG surgery (OPCABG; n = 21). Blood samples for measurements of ADMA, SDMA, and L-arginine were withdrawn and determined by liquid chromatography-tandem mass spectrometry from the coronary sinus (CS) and from the peripheral vein. RESULTS: On the basis of the intraoperative (CS) samples, ADMA levels rose in the CPB group (F = 0.416, P < 0.685 and F = 14.751, P < 0.001 for OPCABG and CPB groups, respectively). A similar significant increase of ADMA was observed in the peripheral blood (F = 30.738, P < 0.001) during CPB, whereas ADMA levels remained unchanged during OPCABG. The time course of L-arginine levels was significantly different in the blood samples from CS (F = 3.255, P<0.05), when compared with samples from the peripheral blood (F = 3.255, P < 0.05). The values of the L-arginine/ADMA ratio were significantly higher in the OPCABG group at baseline and on the first postoperative day compared with the results of the CPB group (178.29 ± 11.56 vs. 136.28 ± 13.72 and 129.43 ± 7.08 vs. 106.8 ± 6.9 for OPCABG and CPB groups, respectively). CONCLUSION: Plasma levels of ADMA, SDMA, L-arginine, and L-arginine/ADMA ratio are reliable and feasible markers of an early ischemia-reperfusion injury. During CPB operation, the plasma concentration of ADMA increased significantly and remained elevated until the first postoperative day due to extensive ischemia-reperfusion injury caused by CPB.


Asunto(s)
Arginina/análogos & derivados , Puente Cardiopulmonar , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/cirugía , Anciano , Arginina/sangre , Biomarcadores/sangre , Cromatografía Líquida de Alta Presión , Femenino , Humanos , Masculino , Persona de Mediana Edad , Daño por Reperfusión/sangre , Espectrometría de Masas en Tándem
18.
J Hypertens ; 28(10): 2068-75, 2010 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-20651604

RESUMEN

BACKGROUND: The importance of measuring aortic pulse wave velocity (PWVao), aortic augmentation index (Aix) and central systolic blood pressure (SBPao) has been shown under different clinical conditions; however, information on these parameters is hard to obtain. The aim of this study was to evaluate the accuracy of a new, easily applicable oscillometric device (Arteriograph), determining these parameters simultaneously, against invasive measurements. METHODS: Aortic Aix, SBPao and PWVao were measured invasively during cardiac catheterization in 16, 55 and 22 cases, respectively, and compared with the values measured by the Arteriograph. RESULTS: We found strong correlation between the invasively measured aortic Aix and the oscillometrically measured brachial Aix on either beat-to-beat or mean value per patient basis (r = 0.9, P < 0.001; r = 0.94, P < 0.001), which allowed the noninvasive calculation of the aortic Aix without using generalized transfer function. Similarly strong correlation (r = 0.95, P < 0.001) was found between the invasively measured and the noninvasively calculated central SBPao; furthermore, the BHS assessment of the paired differences fulfilled the 'B' grading. The PWVao values measured invasively and by Arteriograph were 9.41 ± 1.8 m/s and 9.46 ± 1.8 m/s, respectively (mean ± SD); furthermore, the Pearson's correlation was 0.91 (P < 0.001). The limits of agreement were 11.4% for aortic Aix and 1.59 m/s for PWVao. CONCLUSION: Aix, SBPao and PWVao, measured oscillometrically, showed strong correlation with the invasively obtained values. The observed limits of agreement are encouragingly low for accepting the method for clinical use. Our results suggest that the PWVao values, measured by Arteriograph, are close to the true aortic PWV, determined invasively.


Asunto(s)
Angiografía/métodos , Aorta/fisiología , Velocidad del Flujo Sanguíneo/fisiología , Presión Sanguínea/fisiología , Oscilometría/métodos , Flujo Sanguíneo Regional/fisiología , Anciano , Angiografía/instrumentación , Arteria Braquial/fisiología , Elasticidad/fisiología , Femenino , Humanos , Hungría , Italia , Masculino , Persona de Mediana Edad , Oscilometría/instrumentación , Reproducibilidad de los Resultados
19.
Int J Mol Med ; 25(4): 617-24, 2010 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-20198311

RESUMEN

The study was designed to compare the response pattern of plasma l-arginine and methylarginines to stent placement in patients with or without ST segment elevation myocardial infarction (STEMI). Two groups of patients with obstructive coronary artery disease (OCAD) undergoing percutaneous coronary intervention (PCI) with stenting were enrolled in the study. Group I consisted of 16 patients with STEMI, whereas group II included 24 patients without STEMI (controls). Before PCI and at <1 h, 5 and 30 days after reperfusion, blood samples were taken for measurement of l-arginine and methylarginines. L-arginine, asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), N-monomethylarginine (MMA) and l-ornithine plasma levels were measured by LC-MS-MS. Arginine methylation index (Arg-MI) was calculated according to the formula, Arg-MI = (ADMA+SDMA)/MMA. In patients without STEMI, stenting induced a prompt and sustained depression of ADMA (p<0.000), and l-ornithine (p<0.000) with simultaneous increase of l-arginine (p<0.001), l-arginine/ADMA ratio (p<0.000) and an inconsistent change in MMA. Arg-MI remained at the baseline value. By contrast, STEMI patients responded to stent placement with a variable increase in l-arginine (p<0.01), ADMA (p<0.069), SDMA, MMA (p<0.01) and l-ornithine (p<0.000), whereas there was an early fall of Arg-MI after stenting, followed by a steady increase approaching the initial values. The differences in the time-course for ADMA (p<0.000), MMA (p<0.007), Arg-MI (p<0.01) and l-ornithine (p<0.003) proved to be significant between the STEMI and control group. It can be concluded therefore, that stent placement improves endothelial dysfunction in patients with OCAD when it is not complicated by STEMI.


Asunto(s)
Arginina/análogos & derivados , Infarto del Miocardio/sangre , Infarto del Miocardio/diagnóstico por imagen , Stents/efectos adversos , Angioplastia Coronaria con Balón , Arginina/sangre , Estudios de Casos y Controles , Angiografía Coronaria , Femenino , Humanos , Masculino , Metilación , Persona de Mediana Edad , Ornitina/sangre , Ultrasonografía
20.
Med Sci Monit ; 15(9): CR470-6, 2009 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-19721398

RESUMEN

BACKGROUND: Cognitive deficit related to open heart surgery came into the focus of interest according to professional and social expectations. The negative effects on quality of life and the large number of involved patients emphasize the need its investigation. MATERIAL/METHODS: The bedside measurement of simple and choice reaction times (sRT and cRT) has the objectivity of cortical evoked potential analysis without the need for EEG instrumentation and laboratory. This is a functional assessment similar to neuropsychological tests, but requires a significantly shorter time and is less demanding for the patient. RESULTS: Fifty patients who had undergone open heart surgery were investigated. Statistically significant positive correlation of sRT and cRT prolongation and perfusion time was found. At the same time there were no statistically significant changes in mean sRT and cRT values before (sRT: 208+/-54 s, cRT: 369+/-59 s) and after (sRT: 229+/-67 s, cRT: 392+/-105 s) the surgery, probably due to the inhomogeneous patient population. The weak correlation (coefficients: 0.1418-0.8484) for sRT and cRT changes as a function of perfusion time confirms the presence of other factors of postoperative brain damage. CONCLUSIONS: The investigated bedside test is clinically feasible, simple, and can be completed within 30 minutes. Further studies are encouraged to compare this method with other tests in a larger, stratified cardiac surgery population.


Asunto(s)
Trastornos del Conocimiento , Circulación Extracorporea/efectos adversos , Sistemas de Atención de Punto , Desempeño Psicomotor/fisiología , Tiempo de Reacción/fisiología , Adulto , Anciano , Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Análisis de Regresión , Cirugía Torácica/métodos
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