ISRN Vascular Medicine The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Threatening Inferior Limb Ischemia: When to Consider Fasciotomy and What Principles to Apply? Tue, 04 Mar 2014 08:34:01 +0000 Inferior limb compartmental syndrome (CS) gathers a constellation of symptoms that traditionally refers to pathologically increased intramuscular and surrounding tissue pressure generally contained in nonexpansile leg spaces. It associates oftentimes reperfusion or traumatic injury. Intrinsic rigidity of these leg and foot closed compartments may enhance critical pressure risings with deleterious effects on specific vascular and nervous supply, with two main presentations: acute versus chronic display. For these situations, early fasciotomy plays the major role of releasing specific compartment hypertension and prevents deleterious tissue necrosis. Intervention is effective only if required upon precise indications (measured tissue pressure within 20 to 30 mm Hg of systemic diastolic pressure) and performed correctly in a timely fashioned approach. Any failure or delay in recognizing CS inevitably leads to adverse outcomes and jeopardy for secondary limb loss. When judiciously applied during or soon after limb-salvage revascularization technically successful fasciotomy may represent a major contributor in limb preservation. It accounts for a well-defined therapeutic proceeding available for any conscientious and well-briefed interventionist. Vlad-Adrian Alexandrescu and Didier Van Espen Copyright © 2014 Vlad-Adrian Alexandrescu and Didier Van Espen. All rights reserved. Vascular Tissue Engineering: Recent Advances in Small Diameter Blood Vessel Regeneration Tue, 28 Jan 2014 09:35:54 +0000 Cardiovascular diseases are the leading cause of mortality around the globe. The development of a functional and appropriate substitute for small diameter blood vessel replacement is still a challenge to overcome the main drawbacks of autografts and the inadequate performances of synthetic prostheses made of polyethylene terephthalate (PET, Dacron) and expanded polytetrafluoroethylene (ePTFE, Goretex). Therefore, vascular tissue engineering has become a promising approach for small diameter blood vessel regeneration as demonstrated by the increasing interest dedicated to this field. This review is focused on the most relevant and recent studies concerning vascular tissue engineering for small diameter blood vessel applications. Specifically, the present work reviews research on the development of tissue-engineered vascular grafts made of decellularized matrices and natural and/or biodegradable synthetic polymers and their realization without scaffold. Valentina Catto, Silvia Farè, Giuliano Freddi, and Maria Cristina Tanzi Copyright © 2014 Valentina Catto et al. All rights reserved. Postoperative Tachyarrhythmias: On-Pump versus Off-Pump Coronary Artery Bypass Grafting Sun, 12 Jan 2014 00:00:00 +0000 Objective. Tachyarrhythmias, after coronary artery bypass graft (CABG) surgery, develop in 11%–40% of patients. Surgery technique (on-pump or off-pump) might affect incidence of post-CABG tachyarrhythmias. Methods. The study included 60 patients undergoing CABG (≥2 grafts) with left ventricle ejection fraction (LV EF) >40%. Patients were divided into two groups equally: group A (on-pump) and group B (off-pump). Patients were subjected to electrocardiographic monitoring (7 days postoperatively), transthoracic echocardiography, with recording of surgical details and complications. Results. Data collected between December 2012 and May 2013 showed no significant difference between two groups regarding incidence of postoperative tachyarrhythmias with statistically significant higher incidence of supraventricular tachycardia in group B () and a trend towards higher incidence of atrial fibrillation in group A. Patients who developed postoperative tachyarrhythmias in group A showed higher prevalence of family history of coronary artery disease and higher incidence of postoperative chest infections (), while those in group B showed higher mean LV EF (pre- and postoperatively) (). Data were statistically described in terms of mean ± standard deviation. Comparison of numerical and categorical variables was done using Student’s - and Chi-square tests, respectively. Conclusion. Adopting off-pump CABG technique is not associated with less incidence of post-operative tachyarrhythmias, as compared to on-pump technique. Mohamed Shehata, Bassem AbdElhalim, Hany Hanna, and Mervat Nabih Copyright © 2014 Mohamed Shehata et al. All rights reserved. Lipid Lowering Therapy with Combination of Niacin and Statin in Women: Age-Related Endothelial Effects Sat, 28 Dec 2013 11:00:21 +0000 Background. Many women remain at risk for cardiac events despite treatment to reduce low-density lipoprotein cholesterol (LDL-C). We hypothesized that for postmenopausal women treated with niacin in addition to statin vascular function will improve. Methods. We conducted a randomized, double-blind, placebo-controlled trial of 16 weeks of niacin (N) versus placebo (PL) in 43 women (mean age, years) previously on statin therapy. Study outcomes included lipoprotein levels, vascular inflammation assessed by high sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6), tumor necrosis factor α (TNF-α), and endothelial function, assessed as brachial artery flow mediated dilation (FMD). Results. The N group significantly increased HDL-C and decreased LDL-C cholesterol relative to PL (both ). FMD improved in both groups () irrespective of niacin (). Age influenced change in FMD () such that improved FMD (before to after) with lipid lowering therapy was greater with older age ( Pearson correlation = 0.34), independent of treatment group. Conclusions. Lipid lowering therapy with combination of niacin and statin does not improve inflammation or endothelial function compared to statin alone. However, older women demonstrate relatively greater endothelial benefit of lipid lowering therapy over 4 months. This trial is registered with NCT00590629. Beth Parker, Kamlesh Kothawade, Namee Kim, Maura Paul-Labrador, Noel Bairey Merz, and Donna Polk Copyright © 2013 Beth Parker et al. All rights reserved. Tumour Thrombi in the Suprahepatic Inferior Vena Cava: The Cardiothoracic Surgeons’ View Thu, 26 Dec 2013 18:38:48 +0000 Background. Retroperitoneal tumours propagate intrathoracic caval tumour thrombi (ICTT) of which we consider two subgroups: ICTT-III (extracardiac) and ICTT-IV (intracardiac). Methods. Case series review. Results. 29 series with 784 patients, 453 with extracardiac and 331 with intracardiac ICTT. Average age was 59 years. 98% of the tumours were RCC, 1% adrenal and Wilms’ tumours, and 1% transitional cell carcinomas. The prevalent incision was rooftop with or without sternotomy. Mortality was 10% (5% for ICTT-III, 15% for ICTT-IV). Morbidity was 56% (36% for ICTT-III, 64% for ICTT-IV) and reoperation for bleeding was the commonest complication (14%). Mean Blood loss was 2.6 litres for ICTT-III and 3.7 litres for ICTT-IV. Mean blood product use was 2.4 litres for ICTT-III and 3.5 litres for ICTT-IV. Operative and anaesthetic times exceeded 5 hours. Hospital stay averaged 13 days. Variations in perioperative care included preoperative embolisation, perioperative transoesophageal echo, surgical incisions, and extracorporeal circulation. Brief Summary. Surgery for ICTT has high transfusion, operating/anaesthetic time, and in-hospital stay requirements, and intracardiac ICTT also attract higher risk. Preoperative tumour embolisation is controversial. The cardiothoracic team offers proactive optimisation of blood loss and preemptive management of intracardiac thrombus impaction: we should always be involved in the management the ICTT. Aristotle D. Protopapas, Hutan Ashrafian, and Thanos Athanasiou Copyright © 2013 Aristotle D. Protopapas et al. All rights reserved. The Use of Computed Tomography of Pulmonary Angiogram in a District Hospital Sun, 20 Oct 2013 15:53:13 +0000 Background. Computed tomography of pulmonary angiogram (CTPA) is a widely used investigation in patients with suspected pulmonary embolism (PE). It is not without adverse effects either through contrast injection or radiation exposure. International guidelines suggest that patients with a low/intermediate clinical probability and negative D-dimer do not require CTPA to exclude PE. Method. A retrospective audit of 100 consecutive CTPA scans was performed at a district general hospital from January to May 2012 to assess adherence to the current guidelines for diagnosis of acute PE and utilisation of CTPA. Result. Of the total 88 CTPA scans that were included in the study, 14% were positive for PE. At least 6%, potentially up to 30% of all the scans, could have been avoided by adherence to current guidelines, thereby improving the positive yield to as high as 19%. Clinical probability scores were documented in only 3%. Orthopaedics requested 3% of all scans and the Assessment Treatment and Rehabilitation (ATR) unit had the highest number of CTPA requests per 100 departmental inpatient admissions. Conclusion. Adherence to the current guidelines can reduce the number of CTPA scans required and may reduce cost, contrast exposure, and radiation burden. Bomi Kim, Matthew Hills, and Lutz Beckert Copyright © 2013 Bomi Kim et al. All rights reserved. Repeatability of Peripheral Artery Tonometry in Female Subjects Sun, 20 Oct 2013 11:43:21 +0000 Background. Peripheral arterial tonometry (PAT) is a novel, non-invasive and operator-independent method for simultaneous assessment of endothelial function and arterial stiffness. We examined the repeatability of PAT in females and the influence of the estrous cycle. Methods. In 14 healthy female and five healthy male control subjects, PAT was performed on three separate occasions with 10 days between visits. Reactive hyperemia index (RHI), a measure of endothelial function, and peripheral augmentation index (AIx), a measure of arterial stiffness, were determined with the EndoPAT-2000 system. Intraclass correlation coefficient (ICC) was calculated as a measure of repeatability. Results. In both female and male groups, RHI and AIx did not differ between the three measurements (all n.s. by 1-way ANOVA). In females, reanalyzing the data after taking phase of estrous cycle into account had no effect on the results. Repeatability for RHI and AIx in females (ICC for RHI = 0.43, ICC for AIx = 0.78) was similar to that in male subjects (ICC for RHI = 0.42, ICC for AIx = 0.63). Conclusions. PAT measurements were not affected by the estrous cycle in females, and repeatability was comparable to that in males. This should facilitate inclusion of female subjects into vascular function studies using PAT. Andrew J. Degnan, Nandini Shah, David M. Carty, John R. Petrie, Christian Delles, and Markus P. Schneider Copyright © 2013 Andrew J. Degnan et al. All rights reserved. Targeted Drug Delivery to Endothelial Adhesion Molecules Tue, 24 Sep 2013 09:03:17 +0000 Endothelial cells represent important targets for therapeutic and diagnostic interventions in many cardiovascular, pulmonary, neurological, inflammatory, and metabolic diseases. Targeted delivery of drugs (especially potent and labile biotherapeutics that require specific subcellular addressing) and imaging probes to endothelium holds promise to improve management of these maladies. In order to achieve this goal, drug cargoes or their carriers including liposomes and polymeric nanoparticles are chemically conjugated or fused using recombinant techniques with affinity ligands of endothelial surface molecules. Cell adhesion molecules, constitutively expressed on the endothelial surface and exposed on the surface of pathologically altered endothelium—selectins, VCAM-1, PECAM-1, and ICAM-1—represent good determinants for such a delivery. In particular, PECAM-1 and ICAM-1 meet criteria of accessibility, safety, and relevance to the (patho)physiological context of treatment of inflammation, ischemia, and thrombosis and offer a unique combination of targeting options including surface anchoring as well as intra- and transcellular targeting, modulated by parameters of the design of drug delivery system and local biological factors including flow and endothelial phenotype. This review includes analysis of these factors and examples of targeting selected classes of therapeutics showing promising results in animal studies, supporting translational potential of these interventions. Vladimir R. Muzykantov Copyright © 2013 Vladimir R. Muzykantov. All rights reserved. Suppression of Receptor for Advanced Glycation End Products Improves Angiogenic Responses to Ischemia in Diabetic Mouse Hindlimb Ischemia Model Sun, 08 Sep 2013 08:56:43 +0000 Background. The role of the receptor for advanced glycation end products (RAGE) for the impaired angiogenic response in diabetic patients is not well known. We investigated the impact of RAGE suppression by soluble RAGE (sRAGE) on the angiogenic response in a diabetic hindlimb ischemia mouse model. Materials and Methods. Hindlimb ischemia model was prepared by ligation of femoral artery in diabetic and nondiabetic mice. Ischemia-induced angiogenic response was evaluated by laser-Doppler perfusion imaging, muscle capillary density, and protein expression of vascular endothelial growth factor (VEGF) and high-mobility group box (HMGB)-1. Results. Diabetic mice showed attenuated recovery of ischemic limb perfusion on laser-Doppler perfusion imaging compared with nondiabetic mice. The treatment with sRAGE significantly improved blood flow in the ischemic limbs of diabetic mice. The expression levels of VEGF and HMGB-1 in the limb muscle tissues of diabetic mice were lower than in those of nondiabetic mice. The treatment with sRAGE significantly increased the VEGF and HMGB-1 protein expression in the ischemic limb muscle tissues in the diabetic mice. Conclusion. The suppression of RAGE by sRAGE administration improved angiogenic response to ischemia in diabetic mice and was associated with increased HMGB-1 and VEGF levels in muscle tissues. Bo Hyun Kim, Young-Guk Ko, Sun Hwa Kim, Ji Hyung Chung, Ki-Chul Hwang, Donghoon Choi, and Yangsoo Jang Copyright © 2013 Bo Hyun Kim et al. All rights reserved. Bronchial and Nonbronchial Systemic Artery Embolization in Management of Hemoptysis: Experience with 348 Patients Mon, 26 Aug 2013 09:45:49 +0000 Background. We aimed to report our experience with bronchial artery embolization (BAE) in the management of moderate recurrent and/or life-threatening hemoptysis. Methods. We evaluated the demographics, clinical presentation, radiographic studies, short- and long-term efficacy, and complications in patients Who underwent BAE, at a tertiary university hospital, from 2003 to 2012. Results. Three hundred forty-one patients underwent BAE for the management of moderate recurrent or life-threatening hemoptysis. Pulmonary TB and bronchiectasis were the most common etiologies for hemoptysis in our locality. The most common angiographic signs for hemoptysis were hypervascularity and systemic-pulmonary artery shunt. BAE was successful in controlling hemoptysis immediately in 95% of patients and at 1 month in 90% of patients. Recurrence of hemoptysis was observed in 9.6% of patients, and reembolization was indicated in 85% of those cases. Complications of BAE were self-limited acute and subacute complications, while chronic complications were not recorded during this study. Conclusions. TB and bronchiectasis are the commonest etiologies for moderate recurrent or life-threatening hemoptysis in our locality. Hypervascular lesions from the bronchial arteries and nonbronchial systemic arteries represented the major vascular abnormalities. Bronchial and nonbronchial systemic artery embolizations were effective to control both acute and chronic hemoptyses, with no serious complications. Gamal M. Agmy, Safaa M. Wafy, Sherif A. A. Mohamed, Yaser A. Gad, Hisham Mustafa, and Abd El-Salam Abd El-Aziz Copyright © 2013 Gamal M. Agmy et al. All rights reserved. Acquired Carotid-Jugular Fistula: Its Changing History and Management Mon, 08 Jul 2013 09:19:32 +0000 Purpose. To highlight the changes that have come about in recent years in the etiology, diagnosis, and treatment of acquired carotid-jugular fistulas. Methods. We present a review of the literature on acquired carotid-jugular fistulas (CJFs), which includes studies from World Wars I and II up to today and a retrospective analysis of the lesion reports published in the period 2000–2012, with an update of Talwar's table. The case study of one patient suffering from an untreated, long-standing CJF recently treated by us is also presented and included in the updated table. Results. Thanks to early treatment of acute lesions by reconstructive and endovascular surgery, incidence of posttraumatic carotid-jugular fistulas is decreasing, while the number of iatrogenic ones due to medical advances is concomitantly increasing, specifically because of the ever more widespread use of central venous catheters for venous pressure monitoring, parenteral nutrition, and hemodialysis. Conclusion. Although such lesions seem destined to diminish in the future thanks to the above-mentioned diagnostic and therapeutic advances, the increasing number of internal jugular vein catheterizations performed worldwide implies that physicians will still be dealing with carotid-jugular fistulas for many years to come. Claudio Caldarelli, Marco Biricotti, Gabriele Materazzi, Claudio Spinelli, and Roberto Spisni Copyright © 2013 Claudio Caldarelli et al. All rights reserved. Association of Leukotriene Gene Variants and Plasma LTB4 Levels with Coronary Artery Disease in Asian Indians Wed, 05 Jun 2013 11:28:52 +0000 Leukotrienes are potent inflammatory and lipid mediators that participate in atherosclerosis. We analyzed the association of Leukotriene gene (ALOX5, ALOX5AP, LTA4H, and LTC4S) polymorphisms and plasma Leukotriene B4 (LTB4) levels with coronary artery disease (CAD) in a representative cohort of Asian Indians. In all, 136 functional single nucleotide polymorphisms (SNPs) were selected using in silico tools. Forty-five polymorphic SNPs were ranked for predicted functional effect using FastSNP. Finally, 14 functional SNPs along with 10 SNPs identified from the literature were genotyped in 340 CAD patients and 340 controls. Plasma LTB4 levels were measured in 150 cases and 150 controls. None of the 24 SNPs showed significant association with CAD. Plasma LTB4 levels were higher in cases than in controls ( pg/mL versus  pg/mL) (), with greater risk being associated with the top quartile as compared to the bottom quartile after adjusting for potential confounders (OR 8.94, 95% CI 2.56–31.95; ). Four SNPs in the LTA4H gene showed significant association with LTB4 levels () of which rs1978331 () remained significant after correction for multiple testing. LTB4 showed strong correlation with lipids (–34) only in cases. Our pilot study suggests that the association between Leukotrienes gene polymorphisms and CAD risk may be modulated through plasma LTB4 levels. Jiny Nair, Jayashree Shanker, Prathima Arvind, Srikarthika Jambunathan, and Vijay V. Kakkar Copyright © 2013 Jiny Nair et al. All rights reserved. 4-Year Outcome Analysis of Endoscopic Vein Harvesting for Coronary Artery Bypass Grafting Wed, 20 Mar 2013 17:57:02 +0000 Objective. Despite increasing recognition that endoscopic vein harvesting (EVH) is associated with decreased leg wound morbidity, improved cosmetic results, and enhanced patient satisfaction, concerns persist regarding the safety and efficacy of EVH. This study compares in-hospital and midterm outcomes for EVH and open vein harvesting (OVH) at our institution. Methods. 772 patients with EVH were propensity matched to 772 patients who had OVH. Their data were prospectively entered into the cardiac surgery database (PATS; Dendrite Clinical Systems, Ltd., Oxford, UK) and analyzed, retrospectively. The mean duration of followup was 26.4 ± 10.3 months. Results. EVH was associated with a significant reduction in rate of donor site infection compared to OVH (0.39% versus 3.9%, ). Short- and medium-term vein graft patency was similar. After adjusting for clinical covariates, EVH did not emerge as an independent predictor of readmission to hospital for cardiac causes (odds ratio (OR) 1.19, 95% confidence interval (CI) 0.96–1.58, and ), medium-term mortality (hazard ratio (HR) 1.28, 95% CI 1.09–1.42, and ), and need for reintervention (HR 1.21, 95% CI 0.98–1.32, and ). Risk-adjusted survival was 94% for EVH patients and 93% for OVH patients () during the medium-term followup. Conclusion. Our analysis confirms the short- and midium-term safety and efficacy of EVH. Shahzad G. Raja, Melissa Rochon, Camilla Sproson, and Toufan T. Bahrami Copyright © 2013 Shahzad G. Raja et al. All rights reserved. The SAAAVE Act and Routine Ambulatory Medical Care Fail to Diagnose Patients with Abdominal Aortic Aneurysms prior to Rupture: A Single-Institution Experience Tue, 12 Feb 2013 14:18:34 +0000 Objectives. To demonstrate that routine ambulatory medical evaluation in the outpatient setting and current utilization of the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act are inadequate methods to diagnose abdominal aortic aneurysms (AAA) prior to rupture. Methods. A retrospective review was performed on patients with ruptured AAA (rAAA) at a single institution. All patients who were evaluated in an ambulatory care setting within 6 months of the date of rupture were identified, and clinical data were analyzed. Results. Between January 1, 2004 and December 31, 2010, there were 149 patients with rAAA. Fifty-two of 149 (34.9%) patients were evaluated in the outpatient setting within 6 months prior to the date of rupture, and these patients form the basis of this study. Thirty-six of 52 (70%) patients were male, average age was 73.5 years, average BMI was 28, and average aneurysm diameter was 76 mm. Only 5/52 (9.6%) patients had physical exam findings suspicious for AAA. Only 9/52 (17%) would have been eligible for the screening abdominal ultrasound under the SAAAVE Act. Conclusions. Routine medical evaluation in the ambulatory care setting and current utilization of AAA screening methods are inadequate at detecting AAA in the at-risk population prior to rupture. Kamell Eckroth-Bernard, Robert P. Garvin, Evan J. Ryer, James R. Elmore, and David P. Franklin Copyright © 2013 Kamell Eckroth-Bernard et al. All rights reserved. Does Restenosis Still Hamper the Benefit of Carotid Artery Revascularization? Tue, 12 Feb 2013 11:14:45 +0000 Both carotid endarterectomy (CEA) and carotid artery angioplasty with stenting (CAS) may offer acceptable short-term results in symptomatic or asymptomatic patients with carotid stenosis. Independent on the type of revascularization, the long-term benefit may be limited by recurrent stenosis, especially after endovascular treatment. Pathophysiological studies suggest that atherosclerotic plaque composition is an independent predictor of restenosis. Identification of certain plaque characteristics could help risk stratify patients in order to decide on the best therapy and minimize the risk of restenosis. Although currently no gold standard exists for the approach of recurrent carotid stenosis, both redo CEA and CAS seem safe therapeutic options. Limited data are available on treatment of recurrent carotid in-stent stenosis. More data are required in order to recommend the best therapy for in-stent restenosis. C. J. de Witte, G. W. van Lammeren, F. L. Moll, and G. J. de Borst Copyright © 2013 C. J. de Witte et al. All rights reserved. Inflammatory Burden but Not Diabetes Mellitus Influences in Prognosis of Endovascular Revascularization in Peripheral Arterial Disease Thu, 07 Feb 2013 16:10:00 +0000 Aims. To determine the effect of inflammatory preoperative burden on the incidence of reintervention and mortality after endovascular therapy (EVT) and to investigate if diabetes mellitus (DM) is involved in these results. Material and Methods. A prospective cohort study with 12-month follow-up period in patients with peripheral artery disease was carried out. hsCRP and fibrinogen assessments were determined. Results. 85 diabetic and 58 nondiabetic patients were included. An increase between basal hsCRP (11.8 mg/L (10.2; 21.5) versus 4.3 mg/L (1.8; 13.9), ) and fibrinogen levels (450 mg/dL (425; 479.1) versus 369 mg/dL (268; 419), ) and the incidence of death during followup was found. A significant increase between higher hsCRP and fibrinogen basal levels and the incidence of reintervention during the follow-up period was also noted ( and , resp.,). There was no difference between DM and non-DM patients in the 1-year need of reintervention (33.3% versus 45%, , resp.,). Basal hsCRP and fibrinogen levels did not significantly differ between DM and non-DM patients who needed reintervention. Conclusions. The prognosis of the EVT is likely marked by the previous inflammatory load, regardless of DM. Silvia Bleda, Joaquin de Haro, Cesar Varela, Ignacio Lopez de Maturana, Javier Rodriguez, and Francisco Acin Copyright © 2013 Silvia Bleda et al. All rights reserved. Acute Effects of Two Angiotensin Receptor Blockers on Vascular Hemodynamics, Arterial Stiffness, and Oxidative Stress in Patients with Mild to Moderate Hypertension: An Open Label Parallel Group Study Wed, 30 Jan 2013 07:57:25 +0000 Introduction. We studied the acute effects of Olmesartan and Telmisartan at baseline and at the end of four weeks on indices of hemodynamics (heart rate HR, blood pressure BP), vascular (carotid femoral pulse wave velocity cf PWV, digital arterial tone expressed as Reflection index RI, and endothelial dependent vasodilator response EDVR), and oxidative stress (serum Malondialdehyde MDA) in hypertensive patients. Materials and Methods. The eligible patients were randomly allocated to either 20 mg Olmesartan or 40 mg Telmisartan. Results. 40 subjects received Olmesartan, and 29 received Telmisartan. After four weeks of treatment the mean changes from baseline in the Olmesartan group versus Telmisartan group are SBP versus  mm Hg, ; DBP versus  mm Hg, ; cf PWV versus  m/s, ; EDVR versus %, ; and MDA versus  ηMol/mL, . Conclusion. Olmesartan showed a better improvement in cf PWV, EDVR, and MDA than Telmisartan with an identical reduction in blood pressure. Rama Mohan Pathapati, Meriga Rajesh Kumar, Bhakthavatsala Reddy Chirra, Madhavulu Buchineni, Sujith TR, Sreebhushan Raju Devaraju, and M. U. R. Naidu Copyright © 2013 Rama Mohan Pathapati et al. All rights reserved. Associations between Pulse Wave Velocity, Aortic Vascular Calcification, and Bone Mineral Density in Chronic Hemodialysis Patients and General Population Sun, 27 Jan 2013 15:28:38 +0000 The aims of this study were to compare PWV, vascular calcification (VC), and bone mineral density (BMD) in chronic hemodialysis patients (CHP) with those of the general population patients (GPP). We evaluated 60 GPP (aged ) compared with 80 CHP (aged ). PWV was determined from time diversity propagation of the carotid and femoral artery by Doppler ultrasound. Lateral lumbar radiography (LLR) of the abdominal aorta was used to determine the overall abdominal aortic calcification (AAC) score. BMD of the hip and the spine was assessed by dual energy X-ray absorptiometry (DEXA). Biochemical parameters (PTH, Ca2+, P, albumin, CRP, etc.) were determined in all participants according to standard laboratory procedures. The mean PWV was  m/s in the GPP and  m/s in the CHP. The mean AAC score was as follows: GPP: , CHP: . The mean BMD at hip was as follow: GPP:  (g/cm2), CHP:  (g/cm2). In the GPP, PWV correlate with VC (), BMD (), albumin (), and CRP (). In the CHP, PWV correlates with VC (), BMD (), albumin (), and CRP (). There is a strong inverse correlation between PWV and BMD and between VC and BMD. There is a positive correlation between PWV and VC. P. Avramovski, P. Janakievska, M. Koneska, K. Sotiroski, and A. Sikole Copyright © 2013 P. Avramovski et al. All rights reserved. MicroRNAs in Cardiovascular Regenerative Medicine: Directing Tissue Repair and Cellular Differentiation Wed, 16 Jan 2013 15:06:33 +0000 MicroRNAs (miRNAs) are a class of short noncoding RNA molecules, approximately 22 nucleotides in length, which regulate gene expression through inhibition of the translation of target genes. It is now generally accepted that miRNAs guide processes and cellular functions through precise titration of gene dosage, not only for a single gene but also controlling the levels of a large cohort of gene products. miRNA expression is altered in cardiovascular disease and may thereby limit and impair cardiovascular repair responses. Increasing evidence of the essential role of miRNAs in the self-renewal and differentiation of stem cells suggests the opportunity of using the modulation of miRNA levels or their function in directing cell transplantation, cell behavior, and thereby organ healing. In this paper, an overview of miRNA biogenesis and their way of action and different roles that miRNAs play during the myocardial responses to injury and upon cell transplantation will be provided. We focused on cardiomyocyte survival, angiogenesis, extracellular matrix production, and how miRNAs can direct cell plasticity of injected cells and thus drive differentiation for cardiovascular phenotypes, including vascular differentiation and cardiomyocyte differentiation. Joost P. G. Sluijter Copyright © 2013 Joost P. G. Sluijter. All rights reserved. Intracoronary Imaging and Histopathology of Late Phase In-Stent Restenosis after Coronary Stent Implantation Sun, 23 Dec 2012 10:22:29 +0000 In the field of coronary artery stenting, restenosis issue has been almost resolved after development of drug-eluting stents (DESs). In-stent restenosis (ISR) is generally considered to be a stable process, with an early peak in intimal hyperplasia followed by a quiescent period beginning 1 year after stent implantation. However, recently, extended-term problem (over 1 year) in both bare-metal stents (BMSs) and DES has been reported. This phenomenon seems to be different from early ISR within one year in terms of its mechanism, prevention, and treatment. In this paper, we discuss this topic from the standpoint of intracoronary imagings and histopathology, referencing several interesting cases we experienced. Shigenori Ito, Kosuke Nakasuka, Satoru Sekimoto, Kazuyuki Miyata, Masahiko Inomata, Takayuki Yoshida, Nozomu Tamai, Tomoaki Saeki, Shin Suzuki, Yoshimasa Murakami, and Koichi Sato Copyright © 2012 Shigenori Ito et al. All rights reserved. Mild External Compression of the Leg Increases Skin and Muscle Microvascular Blood Flow and Muscle Oxygenation during Simulated Venous Hypertension Mon, 10 Dec 2012 15:27:35 +0000 We studied the effect of mild external leg compression on both skin and muscle microvascular flow, and muscle oxygenation in the leg of healthy subjects during simulated venous hypertension. Skin and muscle microvascular blood flows were measured using photoplethysmography (PPG), and muscle oxygenation was measured using near-infrared spectroscopy (NIRS). Both PPG and NIRS probes were placed over the anterior compartment of the right leg in 8 healthy subjects. Measurements were taken under three experimental conditions: external leg compression (40 mmHg); simulated venous hypertension (65 mmHg thigh cuff); external leg compression during simulated venous hypertension. Muscle oxygenation was measured only under external leg compression during simulated venous hypertension. Simulated venous hypertension decreased skin and muscle microvascular blood flows from 100% (baseline) to % and % (), respectively. External leg compression during simulated venous hypertension caused 2-fold increases in both skin and muscle microvascular blood flows compared to simulated venous hypertension (). Similarly, external leg compression during simulated venous hypertension significantly restored muscle oxygenation by % compared to its baseline (). Our results demonstrate that mild external leg compression counteracts the decreases in skin microvascular flow, muscle microvascular flow, and muscle oxygenation induced by simulated venous hypertension in the leg. T. B. Neuschwander, B. R. Macias, A. R. Hargens, and Q. Zhang Copyright © 2012 T. B. Neuschwander et al. All rights reserved. Targeted Treatments for Restenosis and Vein Graft Disease Sun, 09 Dec 2012 14:00:35 +0000 Surgery to restore blood flow in arteries blocked by atherosclerotic plaque is a common treatment in cardiovascular disease. Long-term complications of surgical treatment are vein graft disease and restenosis, a renarrowing of the blood vessel after bypass or removal of the culprit atherosclerotic plaque. Attempts to prevent or treat these complications by systemic pharmacological approaches have been largely unsuccessful in the clinic. This has led to an interest in developing targeted or locally delivered strategies. This paper discusses many of the various site-delivered therapies that are under examination as potential antirestenotic and antivein graft disease agents (including antithrombotic, antiproliferative, and anti-inflammatory agents) and why many therapies developed in animal models fail in clinical trials. Techniques of targeted delivery (including stents, “magic bullets,” and adventitial delivery) and delivery systems (including nanoparticles and the use of gene therapy) are also discussed. Anita C. Thomas Copyright © 2012 Anita C. Thomas. All rights reserved. Endothelial Nitric Oxide Synthase (NOS3) +894 G>T Associates with Physical Activity and Muscle Performance among Young Adults Thu, 29 Nov 2012 15:13:39 +0000 Objective. We examined the influence of missense polymorphism, endothelial nitric oxide synthase (NOS3) +894 G>T (rs1799983), on habitual physical activity (PA) and the muscle strength response to resistance training (RT). Methods. Men () and women (;  yr) were genotyped. Subjects reported hr/wk in vigorous and light intensity PA and sitting on the Paffenbarger PA questionnaire. One repetition maximum assessed muscle strength. Multivariable and repeated measures ANCOVA tested differences among NOS3 +894 G>T and PA and RT phenotypes by gender. Results. hr/wk in vigorous intensity PA ( versus ; ), more hr/wk in light intensity PA ( versus ; ), and less hr/wk sitting ( versus ; ) than those with the G allele. Women with NOS3 +894 TT gained more absolute ( versus  kg; ) and relative ( versus %; ) strength than those with the G allele. Conclusions. NOS3 +894 G>T associated with PA among men and women and the muscle strength response to RT among women only. Our findings indicate the need for prospective studies examining the influence of NOS3 variants on PA and the muscle response to RT as well as elucidating underlying mechanistic pathways for the associations observed. Margaux A. Guidry, Matthew A. Kostek, Theodore J. Angelopoulos, Priscilla M. Clarkson, Paul M. Gordon, Niall M. Moyna, Paul S. Visich, Robert F. Zoeller, Paul D. Thompson, Joseph M. Devaney, Heather Gordish-Dressman, Eric P. Hoffman, and Linda S. Pescatello Copyright © 2012 Margaux A. Guidry et al. All rights reserved. Transient Left Ventricular Apical Ballooning in a Postmenopausal Woman with Chronic Liver Disease, Malignancy, and Recent Ischemic Stroke: A Case Report and Review of the Literature Sun, 25 Nov 2012 12:11:17 +0000 Transient left ventricular apical ballooning (TLVAB), or Takotsubo cardiomyopathy, is a poorly understood phenomenon that is thought to be related to a surge of catecholamines under stress conditions that causes microvascular dysfunction and a unique pattern of myocardial stunning. TLVAB occurs in two distinct patient populations: (i) community presentation similar to acute coronary syndrome and (ii) the critically ill. Understanding the differences in presentation, prognosis and management between these two groups may improve the outcome. We present a case of TLVAB developing in a Caucasian postmenopausal female who developed TLVAB suddenly on a background of chronic liver disease, malignancy, and recent ischemic stroke. The patient presented with hemodynamic collapse and was treated with inotropes, vasopressors, and supportive care until cardiac function improved. Additionally, we review the current literature describing the risk factors, pathophysiology, and treatment of TLVAB. Dustin Covell and Nathan Clendenen Copyright © 2012 Dustin Covell and Nathan Clendenen. All rights reserved. Pro- and Anti-Inflammatory Cytokine Networks in Atherosclerosis Mon, 19 Nov 2012 08:43:08 +0000 Despite advances in prevention and treatment, atherosclerotic vascular disease continues to account for significant morbidity, mortality, and economic burden in the western world. Our current understanding of this disease presents atherosclerosis as a chronic inflammatory process involving multiple cell types in various stages of activation, apoptosis, and necrosis. These cells include monocyte/macrophage, dendritic cells, lymphocytes, endothelial cells, and vascular smooth muscle cells. Activation of these cells and their processes is initiated and sustained by a complex network of soluble factors termed cytokines. Cytokines are produced and recognized by both inflammatory and resident vascular cells, allowing crosstalk between these two systems. Cytokines also regulate the phenotype of many of these cell types. Recognizing functions of these cytokines and their effects on cells which populate atherosclerotic plaque is key to uncovering targets of therapeutic intervention. This paper will present recent studies which describe the cellular protagonists of atherosclerosis and the role they play in formation of atherosclerotic plaque. It will also describe the cytokines which have been identified as produced by and directly affecting dysfunction of these cells. Because atherosclerosis is considered an inflammatory condition, emphasis will be placed on inflammatory cytokines and their effects on atherogenesis. We will conclude with new directions in therapeutic strategies and points of emphasis for future research. Michael V. Autieri Copyright © 2012 Michael V. Autieri. All rights reserved. Incidence of the Curvature of a Catheter on the Variations of the Inner Volume: Application to the Peripherally Central Catheters Sun, 18 Nov 2012 16:14:55 +0000 One particular characteristic of peripherally central catheter (PCC), peripherally inserted central catheter (PICC) or totally implantable venous access device (TIVAD), is to be submitted to a rotational movement around the shoulder in the daily routine. The aim of this paper is to show that these movements induce a variation of the inner volume of the catheter which may be responsible for an internal distal pollution of the lumen. The results are presented in the framework of an open discussion on the catheter protocols of use as well as a possible improvement of the materials. Gérard Guiffant, Patrice Flaud, Philippe Dantan, Christian Dupont, and Jacques Merckx Copyright © 2012 Gérard Guiffant et al. All rights reserved. Periprocedural Thromboembolic Events Associated with Angioplasty and Stenting of the Extra- and Intracranial Carotid Artery Assessed by Neurological Status and Diffusion-Weighted Magnetic Resonance Imaging (DWI) Mon, 22 Oct 2012 11:51:02 +0000 Objective. The purpose of this study was to determine the frequency of thromboembolic events associated with angioplasty and stenting of the carotid artery with special regard to extra- or intracranial localization of stenosis. Methods. Twenty patients with symptomatic intracranial or extracranial internal carotid artery stenosis were treated with stenting and/or angioplasty. In 4 patients stenting was technically not feasible (all in the group with intracranial stenosis). All patients underwent diffusion-weighted imaging (DWI) and neurological examination within 48 hours before and after the procedure to detect periprocedural thrombembolic events. Results. Extracranial carotid angioplasty and stenting (eCAS) was technically feasible and successfull without procedure-related neurological complications in all cases. Intracranial stenting (iCAS) was not feasible in four cases including one patient with a fateful course. Concerning the restoration of the vessel diameter intracranial stenting was not as successful as eCAS, but more effective than balloon angioplasty alone. Incidence of thrombembolic events assessed by DWI was low. The detected periprocedural thrombembolic events were small and clinically silent. Conclusion. The risk of thromboembolic events during the endovascular treatment of symptomatic carotid artery stenosis was rather low for intra- and extracranial stenosis of the ICA in our patient sample, but one fatal course was observed. Frank Ahlhelm, Johanna Lieb, Stefan Ulmer, Dirk Ahlhelm, and Wolfgang Reith Copyright © 2012 Frank Ahlhelm et al. All rights reserved. Metabolic Profiling of Patients Undergoing Elective Aortic Aneurysm Repair Surgery: Correlation with Anaerobic Threshold Sun, 21 Oct 2012 15:33:49 +0000 The anaerobic threshold (AT) measured by the cardiopulmonary exercise (CPX) test is becoming an established means of identifying patients at high risk of developing cardiac complications perioperatively. The aim of the present study was to investigate the relationship between AT and the plasma metabolic profile of patients undergoing aortic aneurysm repair surgery to see if an alternative or adjunct to the CPX test could be devised. Plasma was obtained from 15 male patients classified (through preoperative CPX tests) as having high (≥11.0 mL kg−1 min−1) or low (<11.0 mL kg−1 min−1) AT before and 1, 2, 24, 48, and 72 hours after elective open aortic aneurysm surgery. Samples were analysed using 1H-NMR spectroscopy coupled with multivariate statistical analysis. Principal components analysis (PCA) and partial least squares discriminant analysis (PLS-DA) distinguished between low- and high-AT patients postoperatively, with high AT patients being more tightly clustered. High AT patients had higher plasma lipid and lower 3-hydroxybutyrate and acetoacetate levels than low AT patients post-operatively. Similar differences were identified preoperatively. 1H-NMR metabolic profiling of plasma has identified molecules whose concentration correlates with AT scores. These may prove a useful biomarker in conjunction with AT in predicting response to major surgical procedures. Cassey McRae, Susan Howard, Shervanthi Homer-Vanniasinkam, Simon J. Howell, and Julie Fisher Copyright © 2012 Cassey McRae et al. All rights reserved. Nuclear Magnetic Resonance Spectroscopy in the Detection and Characterisation of Cardiovascular Disease: Key Studies Sat, 29 Sep 2012 02:35:33 +0000 Purpose. To review the available literature on the applications of nuclear magnetic resonance (NMR) spectroscopy in cardiovascular disease identification and aetiology. Methods. A systematic literature search of peer-reviewed journals for the period January 2000 to June 2012 was performed using EMBASE and Web of Knowledge (WOK) databases. Several hundred reports were identified. Abstract searching led to the selection of articles included. Results. Numerous studies show the breadth of applications of NMR spectroscopy in relation to cardiovascular disease including lipid and lipoprotein formation, structure, and drug interaction. Lipoprotein and metabolite profiles have been shown to vary with many manifestations of cardiovascular disease. Conclusion. The inherent accuracy and reproducibility of NMR spectroscopy allow subtle differences in lipoprotein and metabolic profiles to be detected. As more information is obtained and cardiovascular disease applications of NMR spectroscopy increase, there is potential that a route towards reducing the burden of this worldwide problem may become evident. Warren Yabsley, Shervanthi Homer-Vanniasinkam, and Julie Fisher Copyright © 2012 Warren Yabsley et al. All rights reserved. New Alternatives for Atherosclerosis Treatment Based on Immunomodulation Thu, 13 Sep 2012 10:52:44 +0000 Atherosclerosis and its derived cardiovascular diseases are a leading cause of death in the western world. The treatment of atherosclerosis is currently based on lipid lowering in combination with anti-inflammatory therapies that slow the progression of atherosclerosis. Still, these therapies are not able to fully inhibit the formation or progression of atherosclerotic lesions. Ever since it was first demonstrated that the immunological system plays an important role during atherogenesis, various different immunotherapeutic approaches have been evaluated with promising results. Notwithstanding that, one of the difficulties in developing effective vaccination strategies for atherosclerosis is the selection of a specific target. So far, vaccination strategies have been based on the targeting of lipid antigens, inflammation-derived antigens, and cell-based vaccination strategies. More recently, strategies aimed at blocking the retention of low-density lipoproteins by arterial proteoglycans have emerged as a promising tool. In the study at hand we reviewed the most relevant advances on atherosclerosis immunotherapy cited in the PubMed database from 1980 to 2012. Livan Delgado Roche and Danay Alfonso Hernández Copyright © 2012 Livan Delgado Roche and Danay Alfonso Hernández. All rights reserved.