111 research outputs found
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Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73724/1/j.1365-2044.1980.tb05005.x.pd
Single stage repair of a complex pathology: end stage ischaemic cardiomyopathy, ascending aortic aneurysm and thoracic coarctation
The not uncommon combination of ascending aortic pathology with late presenting coarctation is a difficult surgical challenge. The two stage approach is usually adopted. The necessity for cardiac transplantation adds to the complexity: a trans-sternal approach and single stage repair become mandatory
Vascular conditioning prevents adverse left ventricular remodelling after acute myocardial infarction: a randomised remote conditioning study
Aims:
Remote ischemic conditioning (RIC) alleviates ischemia–reperfusion injury via several pathways, including micro-RNAs (miRs) expression and oxidative stress modulation. We investigated the effects of RIC on endothelial glycocalyx, arterial stiffness, LV remodelling, and the underlying mediators within the vasculature as a target for protection.
Methods and results:
We block-randomised 270 patients within 48 h of STEMI post-PCI to either one or two cycles of bilateral brachial cuff inflation, and a control group without RIC. We measured: (a) the perfusion boundary region (PBR) of the sublingual arterial microvessels to assess glycocalyx integrity; (b) the carotid-femoral pulse wave velocity (PWV); (c) miR-144,-150,-21,-208, nitrate-nitrite (NOx) and malondialdehyde (MDA) plasma levels at baseline (T0) and 40 min after RIC onset (T3); and (d) LV volumes at baseline and after one year. Compared to baseline, there was a greater PBR and PWV decrease, miR-144 and NOx levels increase (p 15% (odds-ratio of 3.75, p = 0.029). MiR-144 and PWV changes post-RIC were interrelated and associated with LVESV reduction at follow-up (r = 0.40 and 0.37, p < 0.05), in the single-cycle RIC.
Conclusion:
RIC evokes “vascular conditioning” likely by upregulation of cardio-protective microRNAs, NOx production, and oxidative stress reduction, facilitating reverse LV remodelling
Antithrombotic therapy in heart failure: a randomized comparison of warfarin vs. aspirin (HELAS)
It is uncertain whether anti-thrombotic treatment reduces the incidence
of thrombo-embolism in patients with heart failure, so there is a need
for a large scale controlled study to assess the effects of
anti-thrombotic therapy in this setting. We report the design of a
randomized controlled multicenter double blind trial examining the
effects of aspirin, warfarin and placebo in patients with heart failure
on the risk of thrombo-embolism. We planned to recruit 6000 patients
with heart failure without contraindications to anticoagulants or
antiplatelet agents and to follow them for a mean time of 2 years
following randomization. The study was planned to determine the rate of
thrombo-embolic and haemorrhagic events and death among patients
randomized to aspirin, warfarin and placebo, stratified according to the
presence or absence of underlying coronary disease. Ancillary studies
parallel to the main study will attempt to identify clinical and
echocardiographic risk factors for thrombo-embolism and will also
examine whether hemostatic or neurohormonal mechanisms contribute to an
increase in the risk of thrombo-embolism in patients with heart failure.
We hoped that the results of the study would improve the clinical
management and cost-effectiveness of treatment for patients with heart
failure. However, the recruitment of patients proved more difficult than
expected and a number of centers decided not to participate. To avoid a
great delay it was decided by the principal investigators and submitted
to the executive committee to terminate enrolment in this study when 300
patients had been enrolled, and accept that this is a pilot study. (C)
1999 European Society of Cardiology. All rights reserved.
Coronary flow: clinical considerations
In the measurement of coronary blood flow to determine the success of
percutaneous coronary intervention, invasive techniques, coupled with
plaque characterisation and other intracoronary imaging modalities, may
prove invaluable
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