The influence of arterial hypertension on the development of coronary artery disease in angiographic findings

Nadciśnienie tętnicze, obok palenia tytoniu, hiperlipidemii i cukrzycy, jest jednym z głównych czynników ryzyka rozwoju miażdżycy. Przeanalizowano niezbyt liczne opracowania dotyczące obrazu angiograficznego miażdżycy naczyń wieńcowych u osób z nadciśnieniem tętniczym. U chorych z nadciśnieniem tętniczym zmiany miażdżycowe są na ogół bardziej zaawansowane niż u osób z prawidłowymi wartościami ciśnienia, co sugeruje szybszy rozwój miażdżycy. Nieliczne obserwacje wskazują na odmienność morfologiczną zmian miażdżycowych stwierdzanych przy współistnieniu nadciśnienia tętniczego w porównaniu z obrazem miażdżycy występującej z innymi czynnikami ryzyka. Wyniki wielu prac wskazują, że nadciśnienie tętnicze powoduje upośledzenie przepływu krwi, zmniejszając między innymi rezerwę wieńcową, co jest czynnikiem w znacznym stopniu odpowiedzialnym za objawy choroby niedokrwiennej serca występujące mimo braku istotnych zmian miażdżycowych w tętnicach. W badaniach wykazano, że u podłoża zaburzeń przepływu leży dysfunkcja śródbłonka i wynikająca z niej gorsza adaptacja naczyń do zwiększonego zapotrzebowania mięśnia sercowego na tlen. Niektóre doniesienia sugerują, że stosowanie leków przeciwnadciśnieniowych może poprawiać ukrwienie mięśnia sercowego nie tylko poprzez obniżanie ciśnienia, ale również przez wpływ na same naczynia (hamowanie skurczu naczyń, poprawa przepływu).Arterial hypertension is considered to be, together with cigarette smoking, hyperlipidaemia and diabetes one of the main risk factors of the onset of atherosclerosis. In the paper the authors reviewed the studies, not very frequent in the literature, concerning the angiographic picture of the coronary artery atherosclerosis found in individuals with arterial hypertension. In patients with arterial hypertension the atherosclerotic lesions are usually more advanced than in normotensive subjects, this fact suggests a more rapid progression of atherosclerosis under influence of the hypertensive disease. Scarce data indicates specific morphologic characteristics of the atherosclerotic lesions found in patients with concomitant arterial hypertension compared to the morphology of atherosclerotic lesions found in patients with other risk factors. The results of many studies suggest that hypertension causes an impairment of blood flow, diminishing the coronary flow reserve, which is to a great extent responsible for the symptoms of ischemic heart disease, even when no significant atherosclerotic lesions in coronary arteries are present. Many studies indicate that the flow impairment results from endothelium dysfunction and consequent less efficient adaptation of the vessels to the augmented myocardial oxygen demand. Some reviews suggest that the administration of antihypertensive drugs may improve myocardial blood supply not only because of their blood pressure-lowering effects but also due to their direct influence on vessels (inhibition of vasoconstriction, flow improvement)

Multimodality imaging of intermediate lesions: Data from fractional flow reserve, optical coherence tomography, near-infrared spectroscopy-intravascular ultrasound

  Background: Fractional flow reserve (FFR) assesses a functional impact of the atheroma on the myocardial ischemia, but it does not take into account the morphology of the lesion. Previous optical coherence tomography (OCT), intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) studies presented their potential to detect vulnerable plaques, which is not possible by FFR assessment. With the following study, the intermediate lesions were assessed by FFR, OCT and combined NIRS-IVUS imaging to identify plaque vulnerability. Methods: Thirteen intermediate lesions were analyzed simultaneously by FFR, OCT and combined NIRS-IVUS imaging. Results: Two lesions were found to have FFR ≤ 0.80 (0.65 and 0.76). The other 11 lesions had FFR > 0.80 with a mean FFR 0.88 ± 0.049. Two lesions with FFR ≤ 0.80 had plaque burden (PB) > 70% and minimal lumen area (MLA) < 4 mm2, but neither of these 2 lesions were identified as OCT de­fined thin fibrous cap atheroma (TCFA), or NIRS-IVUS possible TCFA. Among the other 11 lesions with FFR > 0.80, 8 were identified as OCT-defined TCFA, 4 had PB > 70%, 6 had MLA < 4 mm2, 2 had both PB > 70% and MLA < 4 mm2, 3 lesions were identified as NIRS-IVUS possible TCFA, and 4 lesions had lipid core burden index > 400. Conclusions: The FFR-negative lesions pose traits of vulnerability as assessed simultaneously by IVUS, OCT and NIRS imaging.

In Vitro Photodynamic Therapy with Chlorin e6 Leads to Apoptosis of Human Vascular Smooth Muscle Cells

Percutaneous coronary intervention has become the most common and widely implemented method of heart revascularization. However, the development of restenosis remains the major limitation of this method. Photodynamic therapy (PDT) recently emerged as a new and promising method for the prevention of arterial restenosis. Here the efficacy of chlorin e6 in PDT was investigated in vitro using human vascular smooth muscle cells (TG/HA-VSMCs) as one of the cell types crucial in the development of restenosis. PDT-induced cell death was studied on many levels, including annexin V staining, measurement of the generation reactive oxygen species (ROS) and caspase-3 activity, and assessment of changes in mitochondrial membrane potential and fragmentation of DNA. Photosensitization of TG/HA-VSMCs with a 170 μM of chlorin e6 and subsequent illumination with the light of a 672-nm diode laser (2 J/cm2) resulted in the generation of ROS, a decrease in cell membrane polarization, caspase-3 activation, as well as DNA fragmentation. Interestingly, the latter two apoptotic events could not be observed in photosensitized and illuminated NIH3T3 fibroblasts, suggesting different outcomes of the model of PDT in various types of cells. The results obtained with human VSMCs show that chlorin e6 may be useful in the PDT of aerial restenosis, but its efficacy still needs to be established in an animal model

Telemedicine in Cardiology: Modern Technologies to Improve Cardiovascular Patients’ Outcomes—A Narrative Review

The registration of physical signals has long been an important part of cardiological diagnostics. Current technology makes it possible to send large amounts of data to remote locations. Solutions that enable diagnosis and treatment without direct contact with patients are of enormous value, especially during the COVID-19 outbreak, as the elderly require special protection. The most important examples of telemonitoring in cardiology include the use of implanted devices such as pacemakers and defibrillators, as well as wearable sensors and data processing units. The arrythmia detection and monitoring patients with heart failure are the best studied in the clinical setting, although in many instances we still lack clear evidence of benefits of remote approaches vs. standard care. Monitoring for ischemia is less well studied. It is clear however that the economic and organizational gains of telemonitoring for healthcare systems are substantial. Both patients and healthcare professionals have expressed an enormous demand for the further development of such technologies. In addition to these subjects, in this paper we also describe the safety concerns associated with transmitting and storing potentially sensitive personal data

Chorzy trudni typowiRatująca życie angioplastyka pnia lewej tętnicy wieńcowej u chorego wysokiego ryzyka

A case a of a life-saving angioplasty of left main coronary artery (LMCA) is presented. A 75 year old patient with a history of diabetes, previous CABG and carotid surgery was admitted to our hospital with symptoms of early post-infarct angina. Coronary angiography revealed significant stenosis of LMCA, in addition to previously known multi-vessel diffuse CAD. Taking into consideration a very high risk of repeat CABG surgery a decision was made to perform an angioplasty. The intervention was carried out with good angiographic effect and the patient was discharged home few days later, free from angina. In 9 month follow-up angiography there was no restenosis in LMCA. In patients to whom cardiac surgery presents very high risk, an angioplasty of LMCA can be life-saving, with good long term effects

Chorzy trudni nietypowiAnomalia naczyniowa – odejście przedniej tętnicy zstępującej od prawej zatoki wieńcowej

A case of a patient with congenital anomaly of coronary blood vessels with left anterior descending artery starting from right coronary sinus is presented. The patient was operated on due to symptoms of myocardial ischaemia by carrying out an off-pump coronary artery bypass graft to left anterior descending artery and obtuse marginal artery, with a very good outcome

Gallato Zirconium (IV) Phtalocyanine Complex Conjugated with SiO₂ Nanocarrier as a Photoactive Drug for Photodynamic Therapy of Atheromatic Plaque

A new conjugate of gallato zirconium (IV) phthalocyanine complexes (PcZrGallate) has been obtained from alkilamino-modified SiO2 nanocarriers (SiO2-(CH2)3-NH2NPs), which may potentially be used in photodynamic therapy of atherosclerosis. Its structure and morphology have been investigated. The photochemical properties of the composite material has been characterized. in saline environments when exposed to different light sources Reactive oxygen species (ROS) generation in DMSO suspension under near IR irradiation was evaluated. The PcZrGallate-SiO2 conjugate has been found to induce a cytotoxic effect on macrophages after IR irradiation, which did not correspond to ROS production. It was found that SiO2 as a carrier helps the photosensitizer to enter into the macrophages, a type of cells that play a key role in the development of atheroma. These properties of the novel conjugate may make it useful in the photodynamic therapy of coronary artery disease