Impaired cerebrovascular reactivity (CVR), an important risk factor for future stroke, is affected by a presence carotid stenosis. However, in some cases CVR can be impaired in the absence of carotid stenosis due to several poorly characterized mechanisms. We hypothesized that arterial stiffening as observed in coronary heart disease (CHD) could be associated with alteration in CVR in CHD patients without carotid stenosis. The study population consisted of patients referred for coronary angiography without significant carotid stenosis (<50 %). CVR was evaluated by breath holding index (BHI) measured with transcranial color code duplex ultrasound. Arterial stiffness was assessed by pulse wave velocity (PWV) measured by the oscillometric method. The extent of coronary atherosclerosis was quantified by Gensini score (GS). Out of 186 subjects, sixty-two patients fulfilled the inclusion and exclusion criteria. BHI decreased with increasing PWV (r = -0.47, p<0.001). Decrease in BHI was significantly inversely associated with GS (r = -0.61, p<0.001). GS was associated with PWV (p<0.001). In conclusion, impaired CVR was associated with increased arterial stiffening in CHD patients in the absence of significant carotid stenosis. Thus, we speculate that increased arterial stiffness may at least partially contribute to the pathophysiology of CVR alteration in coronary artery disease., D. Rucka, J. Marek, Z. Rucklova, J.-C. Lubanda, S. Havranek, J. Skvaril, P. Varejka, M. Chochola, D. Karetova, J. Korinek, A. Linhart., and Obsahuje bibliografii
Omentin is a protein produced by numerous tissues including adipose tissue. Its concentrations are decreased in patients with obesity, type 2 diabetes mellitus (DM) and coronary artery disease (CAD). Experimental studies suggest that omentin may have anti-inflammatory and insulin-sensitizing properties. In the present study, we measured circulating omentin levels and its mRNA expression in epicardial and subcutaneous fat, intercostal and heart muscle before and after elective cardiac surgery in patients with CAD (CAD+, DM-, n=18), combination of CAD and DM (CAD+, DM+, n=9) or with none of these conditions (CAD-, DM-, n=11). The groups did not differ in baseline anthropometric and biochemical characteristics with the exception of higher blood glucose and HBA1c in CAD+, DM+ group. Baseline circulating omentin levels tended to be lower in CAD+, DM- and CAD+, DM+ groups as compared to CAD-, DM- group and cardiac surgery increased its concentration only in CAD-, DMgroup. The change in serum omentin levels during surgery inversely correlated with epicardial fat thickness. While baseline omentin mRNA expression did not differ among the groups in any of the studied tissues, its increase after surgery was present only in subcutaneous fat in CAD-, DM- and CAD+, DM- groups, but not in CAD+, DM+ group. Intercostal muscle omentin mRNA expression increased after surgery only in CAD-, DM- group. In conclusion, cardiac surgery differentially affects omentin levels and subcutaneous fat and skeletal muscle mRNA expression in patients without coronary artery disease and diabetes as compared to patients with these conditions.
As traditional risk factors are unable to fully explain the pathogenesis of coronary artery disease (CAD), novel mechanisms became a target of many investigations. Our aim was to study the response of selected markers to physical exercise. High-sensitive C-reactive protein (hs-CRP), matrix metalloproteinases 2 and 9 (MMP-2, MMP-9), advanced oxidation protein products (AOPP), soluble receptor for advanced glycation end-products (sRAGE), pregnancy-associated plasma protein A (PAPP-A), E-selectin, vascular endothelial growth factor (VEGF) and B-type natriuretic peptide (BNP) levels were measured in serum of 21 CAD patients and in 22 healthy controls at rest and after exercise bicycle stress test performed up to the maximal tolerated effort. At rest, hs-CRP, AOPP, MMP-9 and BNP were significantly elevated in the CAD patients as compared with controls. In contrast, P-selectin was significantly lower in CAD patients and a tendency to lower levels of sRAGE was noted. After exercise MMP-9 and BNP, increased significantly in both groups. In conclusions, CAD patients have elevated hs-CRP, AOPP, MMP-9 and BNP - novel markers related to cardiovascular risk or left ventricular overload. MMP-9 and BNP increase significantly with exercise in both healthy individuals and CAD patients., V. Danzig ... [et al.]., and Obsahuje bibliografii a bibliografické odkazy
A high pulse pressure (PP) is a marker of increased artery stiffness and represents a well-e stablished independent predictor for cardiovascular morbidity and mortality. The objective of the research was to determine whether invasively measured central aortic PP was related to the presence and severity of coronary artery disease. In total 1075 consecutive stable male patients undergoing diagnostic coronary angiography with a preserved left ventricular function were included. Diseased coronary vessel (DCV) was defined by the presence of >50 % stenosis. Men were divided into 3 groups according to the increased value of PP. The average PP in the tertiles was 47.8±7.1 vs. 67.0±4.9 vs. 91.3±12.8 mm Hg (p<0,01). The si gnificant differences of DCV was found among tertiles (1.51±1.11 vs 1.80±1.04 vs. 1.99±0.98 DCV, p<0.01). Aortic PP together with age and hyperlipoproteinemia were found as factors with an independent relationship to DCV according to multivariate linear regression. In conclusions the increased value of aortic PP in the male population is independently connected with more severe atherosclerosis evaluated by the significant number of DCV., J. Pařenica ... [et al.]., and Obsahuje bibliografii a bibliografické odkazy
The aim of our study was to assess if repolarization BSPM were able to evaluate the site, size and severity of chronic ischaemic damages and if BSPM were in any way related to the regional attenuation of myocardial contractility or to the site of coronary artery occlusion. The BSPM were obtained from 69 patients suffering from coronary artery disease confirmed by coronarography, with at least 75 % occlusion of at least one coronary artery. According to the site of single occlusion, or a combination of the sites of multiple occlusions, the patients were divided into 6 subgroups. According to the region of attenuated kinetics the same group of 69 patients was also divided into other 6 subgroups. As in the polarity distribution there was only a limited accordance in BSPM with coronarographie and échocardiographie Findings, in the localization of extreme values there were very important specific changes in patients with normal kinetics as determined by both contrast ventriculography and two-dimensional echocardiography. The repolarization maps can distinguish patients with coronary artery disease and normal echocardiography from healthy persons with a sensitivity of 85 % and a specificity of 65 % in the case of the isoareal map from the ST segment (R1AM) and 90 % and 85 %, respectively, in the case of the isointegral map from the whole ST-T segments (R1IM).
b1_The purpose of this study was to assess the influence of aerobic training on the left ventricular(LV) systolic function. Thirty patients with stable coronary artery disease, who had participated in the conducted 3-month physical training, were retrospectively divided into 2 co horts. While patients in the cohort I(n=14) had continued training individually for 12 months, patients in the cohort II(n=16) had stopped training after finishing the conducted program. Rest and stress dobutamine/atropine echocardiography was performed in all patients before the training program and 1 year later. The peak systolic velocities of mitral annulus (Sa) were assessed by tissue Doppler imaging for individual LV walls. In addition, to determine global LV systolic longitudinal function, the four-site mean systolic velocity was calculated (Sa glob). According to the blood supply, left ventricular walls were divided into 5 groups: A-walls supplied by nonstenotic artery; B-walls supplied by coronary artery with stenosis ≤ 50 %; C-walls supplied by coronary artery with stenosis 51-70 %; D-walls with stenosis of supplying artery 71-99 %; and E-walls with totall y occluded supplying artery. In global systolic function, the follow-up values of Sa glob in cohort I were improved by 0.23±0.36 as compared with baseline values at rest, and by 1.26±0.65 cm/s at the maximal load, while the values of Sa glob in cohort II were diminished by 0.53±0.22(p=NS), and by 1.25±0.45 cm/s(p<0.05), respectively. Concerning the resting regional function, the only significant difference between cohorts in follow-up changes was found in walls E:0.37±0.60 versus -1.76± 0.40 cm/s(p<0.05). At the maximal load, the significant difference was found only in walls A(0.16±0.84 versus -2.67±0.87 cm/s; p<0.05)., b2_Patients with regular 12-month physical activity improved their global left ventricle systolic function mainly due to improvement of contractility in walls supplied by a totally occluded coronary artery., R. Panovský ... [et al.]., and Obsahuje bibliografii a bibliografické odkazy
Enhanced expression of tissue factor (TF) may result in thrombosis contributing to acute clinical consequences of coronary artery disease. Several studies demonstrated elevated plasma levels of TF in patients with acute coronary syndrome (ACS). The aim of our study was to compare the concentrations of TF in coronary sinus (CS), proximal part of the left coronary artery (LCA) and peripheral vein (PV) of patients with ACS and stable coronary artery disease (SCAD). Time course of the TF plasma levels in PV was followed on day 1 and day 7 after index event of ACS presentation and was compared to day 0 values. No heparin was given prior to the blood sampling. Twenty-nine patients in the ACS group (age 63.6±10.8 years, 20 males, 9 females) and 24 patients with SCAD (age 62.3±8.1 years, 21 males, 3 females) were examined. TF plasma level was significantly higher in patients with ACS than in those with SCAD (239.0±99.3 ng/ml vs. 164.3±114.2 ng/ml; p=0.016). There was no difference in TF plasma levels in PV, CS and LCA (239.0± 99.3 ng/ml vs. 253.7±131.5 ng/ml vs. 250.6±116.4 ng/ml, respectively). TF plasma levels tended to decrease only non-significantly on the day 7 (224.4± 109.8 ng/ml). Significant linear correlation between TF and high sensitivity CRP (hs-CRP) levels on day 0 was found. In conclusion, TF plasma levels are elevated in patients with ACS not only locally in CS but also in systematic circulation. Our data support the relationship between TF production and proinflammatory mediators., J. Bis ... [et al.]., and Obsahuje seznam literatury
This study investigated the value of oxygen (O2) pulse curves obtained during cardiopulmonary exercise testing (CPET) for the diagnosis of coronary artery disease (CAD). Forty patients with known coronary anatomy (35.0 % normal, 27.0 % single-vessel and 38.0 % multivessel CAD) underwent CPET with radiotracer injection at peak exercise, followed by myocardial scintigraphy. O2 pulse curves were classified as: A-normal, B-probably normal (normal slope with low peak value); C-probably abnormal (flat, with low peak value); or D- definitely abnormal (descending slope). Sensitivity, specificity, positive and negative predictive values of the O2 pulse curve pattern (A or B vs. C or D) for the diagnosis of CAD were, respectively, 38.5 %, 81.3 %, 76.9 %, and 44.8 %. The concordance rate between the abnormal O2 pulse curve pattern and ischemia in myocardial scintigraphy was 38.1 %. Age and the extent of scintigraphic perfusion defect, but not the abnormal O2 pulse curve patterns (B or C or both combined) were independently associated with CAD. In conclusion, the O2 pulse curve pattern has low diagnostic performance for the diagnosis of obstructive CAD, and the abnormal curve pattern was not associated with myocardial ischemia defined by scintigraphy., A. De Lorenzo, C. L. Da Silva, F. C. Castro Souza, R. De Souza Leão Lima., and Obsahuje bibliografii