Cardiac Imaging and Management of Cardiac Disease in Asymptomatic Renal Transplant Candidates: A Current Update.

Given the high cardiovascular risk accompanying end-stage kidney disease, it would be of paramount importance for the clinical nephrologist to know which screening method(s) identify high-risk patients and whether screening asymptomatic transplant candidates effectively reduces cardiovascular risk in the perioperative setting as well as in the longer term. Within this review, key studies concerning the above questions are reported and critically analyzed. The lack of unified screening criteria and of a prognostically sufficient screening cardiovascular effect for renal transplant candidates sets the foundation for a personalized patient approach in the near future and highlights the need for well-designed studies to produce robust evidence which will address the above questions

The role of patient-oriented mHealth interventions in improving heart failure outcomes: A systematic review of the literature.

Heart failure (HF) is a debilitating disease with 26 million patients worldwide. Consistent and complex self-care is required on the part of patients to adequately adhere to medication and to the lifestyle changes that the disease necessitates. Mobile health (mHealth) is being increasingly incorporated in patient interventions in HF, as smartphones prove to be ideal platforms for patient education and self-help assistance. This systematic review aims to summarize and report on all studies that have tested the effect of mHealth on HF patient outcomes. Our search yielded 17 studies, namely 11 randomized controlled trials and six non-randomized prospective studies. In these, patients with the assistance of an mHealth intervention regularly measured their blood pressure and/or body weight and assessed their symptoms. The outcomes were mostly related to hospitalizations, clinical biomarkers, patients' knowledge about HF, quality of life (QoL) and quality of self-care. QoL consistently increased in patients who received mHealth interventions, while study results on all other outcomes were not as ubiquitously positive. The first mHealth interventions in HF were not universally successful in improving patient outcomes but provided valuable insights for patient-oriented application development. Future trials are expected to build on these insights and deploy applications that measurably assist HF patients

The CD40/CD40 ligand system: linking inflammation with atherothrombosis.

The role of CD40/CD40 ligand (CD40L) in atherothrombosis is now widely accepted. However, the exact mechanisms linking the CD40/CD40L system and the soluble form of CD40 ligand (sCD40L) with atherothrombosis are currently a topic of intensive research. CD40L and sCD40L belong to the tumor necrosis factor superfamily, and they are molecules with a dual prothrombotic and proinflammatory role. They are expressed in a variety of tissues such as the immune system (in both B and T cells), the vascular wall, and activated platelets. Soluble CD40L has multiple autocrine, paracrine, and endocrine actions, and it may trigger key mechanisms participating in atherothrombosis. CD40/CD40L may participate in the development of coronary atherosclerosis and the triggering of acute coronary syndromes, while sCD40L seems to have a prognostic role not only in subjects with advanced atherosclerosis but also in the general population. Although conventional cardiovascular medication such as antiplatelet therapy, statins, angiotensin-converting enzyme inhibitors, and many others have been shown to reduce both sCD40L and cardiovascular risk, it is still unclear whether specific treatments targeting the CD40/CD40L system will prove to be beneficial against atherothrombosis in the near future

Nanoparticles: a promising therapeutic approach in atherosclerosis.

Coronary atherosclerosis is the largest cause of mortality and morbidity in industrialised countries. Despite recent advances in medical therapies, the prevention and treatment of atherosclerosis remain suboptimal. Atherosclerosis is considered to be a chronic inflammatory disease of the arterial wall, involving the accumulation of macrophages and excess low density lipoproteins (LDL), the formation of foam cells which create the atheromatous plaque, resulting in stenosis, aneurysm and plaque rupture leading to acute coronary events. Every step in the atherogenesis process is a potential therapeutic target for both the prevention and regression of atherosclerosis. A novel approach is the use of nanoparticles containing drugs, providing new perspectives in targeted modification of these pathways. Nanoparticles are ultrafine particles sized between 1-100 nm. By using specific methods, nanoparticles can be filled with drugs and achieve targeted drug delivery near the diseased area. In this review article we describe the basic actions of nanoparticles, and we discuss their potential applications in atherosclerosis. We also discuss their advantages and we expose the existing toxicity issues, making it clear however, that the use of nanoparticles is one of the most promising therapeutic strategies against atherosclerosis

Evaluation of endothelial function

Endothelium is a multifunctional signal-transducing surface that regulates vascular homeostasis through the release of a variety of autocrine and paracrine substances, that can lead to the development of atherosclerotic plaques. Therefore, the invasive and non-invasive assessment of endothelial function is widely used as an experimental tool in clinical research, while strong evidence suggests that it could also be used in clinical practice in the near future. Several invasive and non-invasive techniques have been developed during the last two decades to evaluate and quantify endothelial dysfunction. Invasive techniques which involve intracoronary or intrabrachial infusions of vasoacting agents are still considered to be the gold standard for the early detection of endothelial dysfunction. Non-invasive techniques include flow-mediated dilatation (FMD) of peripheral arteries using an ultrasound probe, gauge-strain plethysmography that uses the changes in impedance to evaluate the changes in forearm blood flow during reactive hyperemia and magnetic resonance imaging (MRI) which bears great potential in evaluating vascular anatomy and function due to its high temporal and spatial resolution compared to ultrasound-based techniques. All of these techniques contribute the identification of endothelial dysfunction that mandates more aggressive treatment and better control of cardiovascular risk factors in order to improve patients' prognosis. © 2011 Nova Science Publishers, Inc. All rights reserved

Evaluation of endothelial function

Endothelium is a multifunctional signal-transducing surface that regulates vascular homeostasis through the release of a variety of autocrine and paracrine substances, that can lead to the development of atherosclerotic plaques. Therefore, the invasive and non-invasive assessment of endothelial function is widely used as an experimental tool in clinical research, while strong evidence suggests that it could also be used in clinical practice in the near future. Several invasive and non-invasive techniques have been developed during the last two decades to evaluate and quantify endothelial dysfunction. Invasive techniques which involve intracoronary or intrabrachial infusions of vasoacting agents are still considered to be the gold standard for the early detection of endothelial dysfunction. Non-invasive techniques include flow-mediated dilatation (FMD) of peripheral arteries using an ultrasound probe, gauge-strain plethysmography that uses the changes in impedance to evaluate the changes in forearm blood flow during reactive hyperemia and magnetic resonance imaging (MRI) which bears great potential in evaluating vascular anatomy and function due to its high temporal and spatial resolution compared to ultrasound-based techniques. All of these techniques contribute the identification of endothelial dysfunction that mandates more aggressive treatment and better control of cardiovascular risk factors in order to improve patients' prognosis. © 2011 Nova Science Publishers, Inc. All rights reserved

Platelet-derived chemokines in inflammation and atherosclerosis

Platelets are inflammatory anuclear cells with a well-established role in the development and manifestation of atherosclerosis. Activated platelets secrete a plethora of chemokines including CXCL4 or platelet factor 4 (PF4), CCL5, CXCL12 or stromal cell derived factor-1α (SDF-1α), CXCL16 and others, which initiate or promote local inflammatory processes at sites of vascular injury. These processes are mainly mediated by the recruitment of circulating haematopoietic stem cells, neutrophils, monocytes or lymphocytes on vascular wall. Under acute ischemic conditions platelet-derived chemokines may promote the mobilization of bone marrow-derived progenitor cells and their homing at lesion sites. This review focuses on the role of platelet-derived chemokines in inflammation and atherosclerosis. Further, we discuss the clinical value of plasma levels of chemokines in the prognosis of atherosclerotic heart disease. © 201

Platelet activation in atherogenesis associated with low-grade inflammation.

Further to the established role of platelets in thrombosis and hemostasis, increasing evidence suggests that they also play a crucial role in atherogenesis. Platelets produce a number of agents contributing to the systemic low-grade inflammation implicated in atherogenesis. Platelet activation following inflammatory stimulus leads to the expression of surface receptors such as GPIb/IX/V, P-selectin, CD40, and to the release of several pro-inflammatory agents. Platelet receptors and released molecules play a critical role during the initiation and the progression of atherosclerosis by mediating leukocytes recruitment and adhesion to the vascular wall. Endothelial dysfunction, an early feature in atherosclerosis, is associated with low-grade inflammation within the vascular wall, and it leads to the reduced bioavailability of nitric oxide. Dysfunctional endothelium itself releases inflammatory molecules leading toward platelets activation and adhesion to the vascular wall. Platelets are no longer considered simply as cells participating in thrombosis. They are regulators of multiple processes in the human body, including inflammation, regulation of endothelial physiology and atherogenesis. The design of new therapeutic strategies targeting platelets and their impact in atherosclerosis-related low-grade inflammation are in the center of current cardiovascular research