Serum myeloperoxidase is independent of the risk factors of atherosclerosis.

OBJECTIVES: The main hypothesis of the study was that as serum myeloperoxidase (MPO) concentration is known to indicate the progression of the atherosclerotic process, MPO may be associated with common risk factors of atherosclerosis. Therefore, the presence of these risk factors (especially elevated glucose and lipid concentrations) should predict an increased MPO level during the subsequent months. We also hypothesized an association of MPO with markers of other chronic diseases involving inflammation. METHODS: Fifty-three patients with ischemic heart disease were followed for 24 weeks by biweekly visits, during which the basic MPO level was measured (500 measurements in total, 2-12 per patient). The association of the patients' typical MPO with the risk factors of atherosclerosis and other personal determinants was examined by trend analysis and analysis of variance. RESULTS: MPO was statistically significantly associated with blood leukocyte, neutrophil, and lymphocyte concentrations of the patients (P=0.001-0.003). MPO was also associated with high-sensitivity C-reactive protein (P=0.02). MPO was not associated with markers of lipid and glucose metabolism, of atherosclerosis, or of other chronic diseases. CONCLUSION: Contradictory to our hypotheses, the results indicate that the serum MPO level is independent of the commonly measured risk factors of atherosclerosis and markers of other chronic diseases. Consequently, the findings suggest that MPO-related acute pathologic events (such as plaque destabilization) are not associated with the preceding glucose or lipid values. However, the results support the third hypothesis and previously reported view that MPO is a marker of inflammation in patients of ischemic heart disease.

Exhaled nitric oxide and atherosclerosis.

BACKGROUND: Fractional exhaled nitric oxide concentration (FENO) measurement has been proposed to be an important adjunct in the diagnosis and management of asthma, pulmonary hypertension and cystic fibrosis. But do we understand how other diseases influence the FENO values? In particular, atherosclerosis is one of the pathological conditions, in which nitric oxide (NO) production is inhibited and its degradation enhanced. Therefore, hypothesis of the current study was that FENO is inversely associated with risk markers of atherosclerosis and with diseases leading secondarily to the progression of atherosclerosis. MATERIALS AND METHODS: A long-term FENO value (median of biweekly measurements over a 24-week period) of 53 patients with ischaemic heart disease (IHD) was compared with the results of clinical and biochemical analyses. RESULTS: Fractional exhaled NO was inversely associated with the plasma concentration of triglycerides (P = 0·01) and with the blood concentration of glycated haemoglobin A1c (P = 0·03). It also tended to be inversely associated with the plasma glucose concentration (P = 0·10). However, there were no statistically significant associations with inflammatory or other biochemical markers, health status, lifestyle or other personal determinants. CONCLUSIONS: In accordance with the hypothesis, FENO is inversely associated with some of risk markers of atherosclerosis in patients with stable IHD (triglycerides and haemoglobin A1c, a marker of hyperglycaemic metabolism). A potential explanation is that, at hyperglycaemia and with higher triglyceride concentrations, atherosclerosis leads to endothelial dysfunction and, subsequently, to decreased production and increased degradation of NO.

Valvular calcification and its relationship to atherosclerosis in chronic kidney disease.

BACKGROUND AND AIM OF THE STUDY: Cardiovascular calcification is a common complication in patients with chronic kidney disease (CKD). The study aim was to identify the characteristics and risk factors of valvular calcification, and its relationship to atherosclerosis, in CKD. METHODS: In this cross-sectional study, a total of 135 patients with CKD (mean age 52 +/- 11 years) included 58 pre-dialysis patients, 36 dialysis patients, and 41 renal transplant recipients. A control group of 58 subjects was also examined. The characteristics of valvular calcification were assessed using transthoracic echocardiography. RESULTS: The combined prevalences of mitral or aortic valve calcification were 31% in pre-dialysis patients, 50% in dialysis patients, 29% in renal transplant recipients, and 12% in controls (p = 0.001). The prevalences of mitral annular calcification were 17%, 31%, 27% and 2%, respectively (p = 0.001). In multivariate analysis, the risk factors for valvular calcification in CKD were age, duration of dialysis treatment and interleukin-6 level. Mitral annular calcification proved to be five-fold more common in diabetic patients than among non-diabetics. A close association between valvular calcification and patients with or without increased carotid intima-media thickness (44% versus 15%, p < 0.001), carotid plaque (77% versus 49%, p = 0.002), calcified carotid plaque (65% versus 26%, p = 0.001), coronary artery disease (40% versus 15%, p = 0.003) and peripheral arterial disease (46% versus 9%, p < 0.001) was found. CONCLUSION: Valvular calcification is common in CKD, and is closely associated with findings of intimal arterial disease. The presence of inflammation and the duration of dialysis treatment contribute to this complication. Diabetes is also a prominent risk factor for mitral annular calcification in CKD.

Effect of long-term endurance and strength training on metabolic control and arterial elasticity in patients with type 2 diabetes mellitus.

Poor glucose control increases the risk of vascular complications and cardiovascular mortality in patients with diabetes mellitus (DM). Our aim was to evaluate the efficacy of a long-term exercise training program on metabolic control and arterial stiffness in patients with type 2 DM. Fifty men with DM (age 52.3 +/- 5.6 years) were randomly assigned to the exercise training (E) or standard treatment for DM (control [C]) group for 24 months. Supervised exercise training included both endurance and muscle strength training 4 times/week. All exercise sessions were controlled by heart rate and intensity. Glycated hemoglobin A1c, insulin, leptin, blood lipids, blood pressure, maximal oxygen consumption in spiroergometry, and muscle strength were measured every 6 months. Arterial stiffness was assessed by measuring pulse wave velocity. Maximal oxygen consumption in spiroergometry (E 31.9 to 34.8 vs C 32.6 to 31.8 ml/kg/min; p = 0.003), muscle strength (sit-up test, E 12.7 to 20.8 vs C 14.6 to 13.1 times; p <0.001), hemoglobin A1c (E 8.2% to 7.6% vs C 8.0% to 8.3%; p = 0.006), and leptin (E 7.4 to 6.7 vs C 7.4 to 7.9 microg/L; p = 0.013) improved significantly in the E group, but no change or worsening in these variables occurred in the C group. Body weight was not different between groups at 2 years. However, pulse wave velocity increased in both groups (E +0.600 vs C +1.300 m/s; p = 0.27). In conclusion, long-term endurance and strength training was effective and resulted in improved metabolic control of DM compared with standard treatment. Despite significant cardiovascular risk reduction, conduit arterial elasticity did not improve.

More than half of the patients with acute Puumala hantavirus infection have abnormal cardiac findings.

This study was conducted to determine the frequency, severity and outcome of cardiac findings in patients with acute Puumala hantavirus-induced nephropathia epidemica (NE). 70 consecutive, hospital-treated patients with serologically confirmed NE were prospectively examined using serial electrocardiograms (ECG), plasma troponin I, tumour necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), and echocardiography (ECHO). Examinations were repeated after 3 and 12 months. ECG changes were observed in 57% of patients. Plasma troponin I levels remained normal in all. In six patients, ECHO showed left ventricular contraction abnormalities, and 1 patient had mild pericardial effusion. There were no differences in clinical or standard laboratory findings or in plasma TNF-alpha and IL-6 concentrations between patients with and without ECG or ECHO changes. During the follow-up, all acute-phase changes in ECG and ECHO reverted to normal, which probably reflects their benign nature. We conclude that abnormal cardiac findings are surprisingly common during NE.

Exercise training does not improve myocardial diastolic tissue velocities in Type 2 diabetes.

BACKGROUND: Myocardial diastolic tissue velocities are reduced already in newly onset Type 2 diabetes mellitus (T2D). Poor disease control may lead to left ventricular (LV) systolic dysfunction and heart failure. The aim of this study was to assess the effects of exercise training on myocardial diastolic function in T2D patients without ischemic heart disease. METHODS: 48 men (52.3 +/- 5.6 yrs) with T2D were randomized to supervised training four times a week and standard therapy (E), or standard treatment alone (C) for 12 months. Glycated hemoglobin (HbA1c), oxygen consumption (VO2max), and muscle strength (Sit-up) were measured. Tissue Doppler Imaging (TDI) was used to determine the average maximal mitral annular early (Ea) and late (Aa) diastolic as well as systolic (Sa) velocities, systolic strain (epsilon) and strain rate (epsilon) from the septum, and an estimation of left ventricular end diastolic pressure (E/Ea). RESULTS: Exercise capacity (VO2max, E 32.0 to 34.7 vs. C 32.6 to 31.5 ml/kg/min, p = .001), muscle strength (E 12.7 to 18.3 times vs. C 14.6 to 14.7 times, p < .001), and HbA1c (E 8.2 to 7.5% vs. C 8.0 to 8.4%, p = .006) improved significantly in the exercise group compared to the controls (ANOVA). Systolic blood pressure decreased in the E group (E 144 to 138 mmHg vs. C 146 to 144 mmHg, p = .04). Contrary to risk factor changes diastolic long axis relaxation did not improve significantly, early diastolic velocity Ea from 8.1 to 7.9 cm/s for the E group vs. C 7.4 to 7.8 cm/s (p = .85, ANOVA). Likewise, after 12 months the mitral annular systolic velocity, systolic strain and strain rate, as well as E/Ea were unchanged. CONCLUSION: Exercise training improves endurance and muscle fitness in T2D, resulting in better glycemic control and reduced blood pressure. However, myocardial diastolic tissue velocities did not change significantly. Our data suggest that a much longer exercise intervention may be needed in order to reverse diastolic impairment in diabetics, if at all possible.

Prediction of coronary artery disease by transesophageal echocardiographic detection of thoracic aortic plaque in patients with chronic kidney disease.

BACKGROUND/AIMS: Our aim was to examine the significance of thoracic aortic plaque detected by transesophageal echocardiography (TEE) in the prediction of coronary artery disease (CAD) in patients with chronic kidney disease (CKD). METHODS: We examined 118 patients (mean age 52 +/- 12 years) with CKD and followed them for a mean of 3.4 +/- 0.8 years. The study group included 52 predialysis patients with moderate to severe CKD (plasma creatinine > or = 200 micromol/l), 32 patients on dialysis treatment, and 34 renal transplant recipients. At baseline, TEE was performed to evaluate thoracic aortic atherosclerosis. CAD was defined by a history of a documented myocardial infarction, a coronary angiogram or a post-mortem autopsy finding showing significant occlusive CAD by the end of the follow-up period. RESULTS: CAD was documented in 31 (26%) of the 118 study patients. The presence of thoracic aortic plaque had a sensitivity of 100% and a specificity of 37% for CAD and the positive and negative predictive values were 36 and 100%, respectively. In the subset of 36 patients with morphological findings of coronary arteries by angiogram or autopsy, the presence of large thoracic aortic plaques (> or = 3 mm in diameter) had a 73% sensitivity and 90% specificity for significant coronary artery stenosis. The positive and negative predictive values were 95 and 56%, respectively. CONCLUSION: TEE may be used for detecting high-risk patients with CKD; the absence of thoracic aortic plaque predicted the absence of CAD, and the presence of large aortic plaques predicted significant coronary artery stenosis.

Impaired myocardial function in newly onset type 2 diabetes associates with arterial stiffness.

AIM: The aim of this study was to evaluate myocardial function using pulsed and color-coded tissue Doppler imaging (TDI) and vascular wall elasticity using whole-body impedance cardiography (ICG) in patients with newly diagnosed Type 2 diabetes mellitus (DM2), and to compare the measurements with those of healthy controls. METHODS: Systolic (SBP) and diastolic (DBP) blood pressure and glycosylated hemoglobin (HbA1c) were measured in 49 men (mean age 52.3+/-5.6 years, duration of DM2 1.8 years), and 15 healthy male control subjects (48.3+/-7.4 years). Mitral annular peak systolic (Svm), early (Evm), and late (Avm) diastolic velocities as well as myocardial peak systolic (Sv), early (Ev) and late diastolic (Av) velocity from middle segments of the anterior, inferior and lateral wall and the inferior septum were measured by TDI. ICG at rest was used to measure cardiac index (CI) and pulse wave velocity (PWV). RESULTS: The patients had higher body mass index (BMI 29.1+/-3.7 vs. 25.2+/-2.4 kg/m(2), p=0.000) and SBP (142+/-15 vs. 120+/-7 mmHg, p=0.005) than the controls, CI was comparable (2.8+/-0.5 vs. 2.8+/-0.6l/min/m(2)). The patients had lower age adjusted myocardial Sv (3.8+/-1.1 vs. 4.8+/-1.1cm/s, p=0.002) and Ev (4.6+/-1.6 vs. 6.2+/-1.7 cm/s, p=0.011), and also mitral annulus peak early diastolic velocity (Evm 7.8+/-1.9 vs. 10.4+/-2.6 cm/s, p=0.001). In diabetic patients PWV (14.2+/-2.7 vs. 10.0+/-1.7 m/s, p=0.002) was higher. Age (r=-0.39, p=0.001), BMI (r=-0.44, p=0.000) and PWV (r=-0.52, p=0.000) correlated significantly with Evm. PWV correlated with age (r=0.50, p=0.000), SBP (r=0.67, p=0.000), and HBA1c (r=0.36, p=0.010). In stepwise regression analysis, PWV (beta=-0.39, p=0.000) was the major determinant of Evm. CONCLUSION: Myocardial function is impaired in asymptomatic patients with newly detected DM2 consistent with diabetic heart muscle disease. Arterial stiffness is strongly related to myocardial dynamics, and both may have the same pathophysiologic background.

Electrocardiographic abnormalities in patients with diphtheria: a prospective study.

PURPOSE: To determine the incidence of and risk factors for electrocardiographic (ECG) abnormalities in adults with diphtheria. METHODS: A prospective study was conducted involving 122 adult patients with respiratory tract diphtheria. Diphtheria was confirmed by isolation of a toxin-producing strain of Corynebacterium diphtheriae. Patients had serial clinical evaluations and ECGs for a minimum of 21 days. RESULTS: Cardiac involvement was detected in 25 (28%) of 88 evaluable patients, with a median time from symptom onset to an abnormal ECG of 9 days (range, 4 to 24 days). In a logistic regression analysis, age (odds ratio [OR] = 4.1; 95% confidence interval [CI]: 1.6 to 11.0), shared accommodation (OR = 2.9; 95% CI: 1.0 to 8.6), fever (OR = 4.2; 95% CI: 1.1 to 16.6), and extensive respiratory tract infection with subcutaneous edema (OR = 7.0; 95% CI: 1.2 to 42.2) were independent risk factors for cardiac involvement. CONCLUSION: Cardiac involvement is a common complication of respiratory tract infection with C. diphtheriae, and occurs more often among older patients, those with lower socioeconomic status, and those with severe respiratory tract involvement.

Risk factors for aortic atherosclerosis determined by transesophageal echocardiography in patients with CRF.

BACKGROUND: The significance of various risk factors for cardiovascular disease (CVD) in the pathogenesis of atherosclerosis in patients with chronic renal failure (CRF) is, to a great deal, unresolved. The high risk for CVD in patients with CRF may be caused by the high prevalence of recognized risk factors for CVD or by factors characteristic of CRF in these patients. In this prospective cross-sectional study, we examined risk factors for thoracic aortic atherosclerosis in a population of patients with CRF consisting of predialysis and dialysis patients, as well as renal transplant recipients. METHODS: Of 118 patients, 52 patients had moderate to severe predialysis CRF, 32 patients were on dialysis treatment, and 34 patients were renal transplant recipients. Mean age was 52 +/- 12 years, and 35 patients (30%) had diabetes. Multiplane transesophageal echocardiography (TEE) was performed using local anesthesia. RESULTS: Large aortic plaques (LAPs; > or = 3.0 mm in diameter) were found in 39 patients (33%). In univariate analysis, age, duration of hypertension, pulse pressure, low diastolic blood pressure, elevated fibrinogen level, C-reactive protein level, total cholesterol level, low-density lipoprotein cholesterol level, and duration of dialysis or a functioning renal transplant were significantly associated (P < 0.05) with LAP. In multivariate analysis, age, duration of hypertension, and total cholesterol level were associated with LAP. CONCLUSION: Results of the present TEE study suggest that in addition to duration of hypertension and renal disease, hypercholesterolemia has a role in the pathogenesis of atherosclerosis in patients with CRF.

Candidate locus analysis of familial ascending aortic aneurysms and dissections confirms the linkage to the chromosome 5q13-14 in Finnish families.

OBJECTIVE: The purpose of the study was to carry out a candidate gene analysis in families with familial thoracic aortic aneurysms and dissections. METHODS: The study material consisted of 11 Finnish families (with 115 members genotyped) who underwent echocardiographic examination for measurement of the aortic root diameter. Selected candidate genes included the loci for Marfan and Ehlers-Danlos syndromes, the genes of matrix metalloproteinases 3 and 9 and tissue inhibitor of metalloproteinase 2 as well two loci on the chromosomes 5q13-14 and 11q23.2-q24, previously found to be linked to the disease. RESULTS: The chromosomal locus 5q13-14 was linked to the disease risk (nonparametric linkage score 3.0, P =.005) confirming the previous linkage. Other candidate genes and loci were excluded as major loci in these families. CONCLUSIONS: The identification of the gene at chromosomal location 5q13-14 causing the development of such diseases would give us important knowledge on the pathogenesis of the disease and enable the identification of subjects at risk. This in turn would lead to appropriate treatment before the occurrence of fatal complications and, likely, to the development of new treatment methods.

Overall and Segmental Agreement of Stress Echocardiography.

Several stress echocardiography (SE) modalities have been introduced for diagnosing coronary artery disease (CAD). Exercise and dobutamine SE are commonly considered to have a better diagnostic accuracy than vasodilator SE. The purpose of this study was to assess the agreement between the test results and the segmental concordance between three SE tests in patients with chest pain. A total of 60 patients (mean age, 55.1 years; SD, 2.1) were tested by symptom-limited bicycle (BSE), dipyridamole-atropine (DiASE), and dobutamine (DSE) tests. CAD (50% stenosis) was present in 44 patients, and 26 patients had one-vessel disease. In BSE and DSE, the double product at peak stress (26.5 and 16.1 vs 13.3 x 10(3), respectively, P < 0.005 vs DiASE) and the peak wall motion score index were higher than in DiASE (1.40 and 1.35 vs 1.26, respectively, P < 0.05 vs DiASE). BSE, DiASE, and DSE did not differ in sensitivity in diagnosing CAD (90%, 93%, and 95%, respectively). Similarly, there were no statistically significant differences in the diagnostic accuracy of BSE, DiASE, and DSE (78%, 88%, and 87%, respectively). The intermethod agreement was moderate between BSE and DiASE (kappa = 0.51), good between BSE and DSE (kappa = 0.62), and moderate between DiASE and DSE (kappa = 0.57). The segmental agreement between BSE, DiASE, and DSE was mostly moderate. Agreement was best between the pharmacologic tests due to test protocols, especially the anterior wall (kappa > 0.60). Also, the basal segments showed good agreement. In conclusion, BSE, DiASE, and DSE have a similar diagnostic accuracy in detecting CAD. The overall agreement between the tests was good, and the assessment of wall motion was variable. Nevertheless, concordant diagnosis of a patient can be obtained by BSE, DiASE, and DSE without loss of diagnostic power.

Echocardiographic Imaging of Right Ventricular Outflow Obstruction During Chemotherapy of Mediastinal Lymphoma.

Transthoracic echocardiography is a versatile method for imaging cardiac complications caused by mediastinal tumors. Especially, the response to therapeutic measures can be assessed promptly. We present echocardiographic imaging of the regression of right ventricular outflow tract obstruction by chemotherapy.

Echocardiographic Imaging of Right Ventricular Outflow Obstruction During Chemotherapy of Mediastinal Lymphoma.

Transthoracic echocardiography is a versatile method for imaging cardiac complications caused by mediastinal tumors. Especially, the response to therapeutic measures can be assessed promptly. We present echocardiographic imaging of the regression of right ventricular outflow tract obstruction by chemotherapy.

Influence of Pulsed-Doppler Sample Volume Location and Upper Body Tilt on Left Ventricular Filling Indices in Healthy Persons.

Doppler echocardiographic analysis of mitral flow is a noninvasive tool for analyzing left ventricular diastolic function. Changes in preload alter both normal and abnormal Doppler patterns of left ventricular filling. The velocities of mitral flow measured by transthoracic pulsed-Doppler echocardiography are different when measured at the mitral leaflet tips and at the mitral annulus. Transesophageal echocardiography provides an excellent image of cardiac anatomy whereby it is possible to place the Doppler sample volume exactly at the mitral annulus or at the tips of mitral leaflets. We studied with the use of transesophageal echocardiography how changes in preload and measurement at the annulus or valve tips affect the velocities of mitral flow. Upper body-up tilting (60 degrees ) decreased maximum E wave velocity by 16% and, hence, E/A ratio by 15%. A wave did not change by tilt. E wave velocity was 13%-15% lower at the annulus than at the tips of the mitral valve in both the supine and tilt position. E/A ratio was significantly higher at the tips than at the annulus of the mitral valve (supine, P = 0.048; tilt, P = 0.001). E/A ratio was 38% lower if the measurements were done at the annulus in the tilt position than at the tips with the patient lying horizontal. It may be important for pulsed-Doppler mitral flow-velocity measurements to be standardized for sample volume location and for body position.