Exercise and cardiovascular diseases.

Exercise is a physiologic stressor that has multiple beneficial effects on cardiovascular system. Currently exercise training is a class I intervention as part of a multifactorial long-term process that includes: clinical assistance, assessment of global cardiovascular risk, identification of specific objective for each cardiovascular risk factor, formulation of an individual treatment plan with multiple intervention aimed at reduction of the risk, educational programs, planning of long term follow-up. This paper reviews the evidences of benefit of exercise in the most common heart diseases and describes the role of exercise training in the cardiac rehabilitation programs

Cardiovascular drugs attenuated myocardial resistance against ischaemia-induced and reperfusion-induced injury in a rat model of repetitive occlusion

We investigated the impact of cardioprotective drugs on ST-elevation, arrhythmias and infarct size in a rat model of repetitive coronary artery occlusion

Charakterisierung der frühen adaptiven zerebralen Arteriogenese

Arteriogenese bezeichnet das adaptive Wachstum von präexistenten kollateralen Arterien. Im Falle eines Arterienverschlusses ist Arteriogenese der endogen effizienteste Kompensationsmechanismus, um das Hypoperfusionsgebiet mit ausreichend Blut zu versorgen (Biologischer Bypasses). In dieser Arbeit wurde das frühe Wachstum von Kollateralgefäßen im Gehirn im ersten Modell für zerebrale Arteriogenese, dem 3-VO Modell (3-vessel occlusion), in der Ratte charakterisiert. (I) Die Untersuchung am nicht-ischämischen 3-VO Hypoperfusionsmodell zeigten, dass 7 Tage nach 3-VO die Arteria cerebri posterior (PCA) signifikant im Diameter anwächst. Histologische Untersuchungen konnten ein vermehrtes Zellwachstum in der PCA und das Einwandern von Makrophagen in den perivaskulären Bereich (24 Stunden und 3 Tage post 3-VO) darstellen und eine Aktivierung des Endothels 3 Tage nach 3-VO wurde mittels Rasterelektronenmikroskopie identifizieren. (II) Für eine genaue Anaylse des globalen Genexpressionsprofils der zerebralen Arteriogense wurde die wachsende PCA selektiv aus dem Gehirn entnommen und ein Genexpressionsprofil für die frühe zerebrale Arteriogenese erstellt (164 Gene dereguliert). Eine Unteruschung von biologischen und molekularen Prozessen zeigte, dass eine Vielzahl der deregulierten Gene in Zellproliferation und Inflammation involviert sind. Die Expression der Protease-Inhibitoren Kininogen und TIMP-1 wurde als “Marker” der frühen Arteriogenese in der PCA lokalisiert werden. Zusammenfassend zeigt diese Arbeit erstmals eine Übersicht der biologischen Prozesse in der zerebralen Arteriogenese und eröffnet neue Ideen für eine mögliche therapeutische Strategie.Arteriogenesis, the adaptive outward growth of pre-existing collateral arteries, is the most efficient endogenous rescue mechanisms in vertebrates against the occlusion of a major artery (biological bypass). Here, collateral growth was induced using the first model for cerebral arteriogenesis, the 3-vessel occlusion (3-VO) rat model. (I) 3-VO resulted in a significant diameter increase within 7 days in the posterior cerebral artery (PCA) and posterior communicating artery (Pcom), classifying the region of interest. Immunhistological staining demonstrated proliferative activation and macrophage invasion, already 24h post 3-VO within the PCA, confirming the arteriogenic phenotype. Furthermore, activation of the PCA endothelium was detected within 3 days post 3-VO by scanning electron microscopy. (II) For analysing the molecular mechanism of cerebral arteriogenesis, collateral tissue from the growing PCA was selectively isolated. Here, 24h post 3-VO 164 genes were detected to be significantly deregulated. Analysis of molecular annotations and networks associated with differentially expressed genes revealed that expression patterns contain gene transcripts predominantly involved in proliferation, inflammation, and migration. Early-phase cerebral arteriogenesis is characterized by protease inhibitor expression and showed that protease inhibitors TIMP-1 and kininogen are molecular markers of early-phase cerebral arteriogenesis. In summary, this work characterizes morphological features and genomic profiles of growing collaterals in the brain and develops novel ideas for a therapeutic stimulation of arteriogenesis

Effect of ACEI and ARB treatment on nitric oxide-dependentendothelial function

<jats:p>Summary: Background: Angiotensin-converting-enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) are widely used as a first-line therapy for the treatment of cardiovascular disease. Here, ACEI modulate the bradykinin receptor (BDKRB1 and BDKRB2) system and NO-dependent endothelial function, thus determining cardiovascular health and regenerative arteriogenesis. The current study aims at evaluating nitric oxide-dependent endothelial function, and gene expression of bradykinin receptors in peripheral blood mononuclear cells (PBMC) from patients with ACEI or ARB treatment. Patients and methods: The WalkByLab has been established to screen cardiovascular patients for peripheral artery disease and coronary artery disease. In total 177 patients from WalkByLab with heterogenous disease and risk status were randomly selected, divided according to their medication history into the following groups: 1. ACEI group, 2. ARB group or 3. non-ACE/ARB group. Total plasma nitrite/nitrate (NO) levels were measured, endothelial function was evaluated by assessing flow meditated dilation (FMD). PBMC were isolated from peripheral whole blood, and gene expression (qRT-PCR) of bradykinin receptors and angiotensin converting enzyme were assessed. Results: Plasma total NO concentration in the ACEI group (24.66±16.28, µmol/l) was increased as compared to the ARB group (18.57±11.58, µmol/l, P=0.0046) and non-ACE/ARB group (16.83±8.64, µmol/l, P=0.0127) in patients between 40 to 90 years of age. However, FMD values (%) in the ACEI group (7.07±2.40, %) were similar as compared to the ARB (6.35±2.13, %) and non-ACE/ARB group (6.51±2.15, %), but significantly negatively correlated with age. Interestingly, BDKRB1 mRNA level was significantly higher and BDKRB2 mRNA level lower in the ACEI group (BDKRB1 3.88-fold±1.05, BDKRB2 0.22-fold±0.04) as compared to the non-ACE/ARB group (BDKRB1 1.00-fold±0.39, P<0.0001, BDKRB2 1.00-fold±0.45, P=0.0136). Conclusions: ACEI treatment enhances total nitrite/nitrate concentration, furthermore, upregulates BDKRB1 in PBMC, but downregulates BDKRB2 mRNA expression. FMD is a strong determinant of vascular aging and is sensitive to underlying heterogenous cardiovascular diseases.</jats:p&gt

Nitroglycerin application and coronary arteriogenesis.

BACKGROUND:In the presence of a coronary occlusion, pre-existing small collateral vessels (arterioles) develop into much larger arteries (biological bypasses) that have the potential to allow a certain level of perfusion distal to the blockage. Termed arteriogenesis, this phenomenon proceeds via a complex combination of events, with nitric oxide (NO) playing an essential role. The aim of this study was to investigate the effects of supplemental administration of NO donors, i.e., short-acting nitroglycerin (NTG) or slow-release pelleted isosorbide dinitrate (ISDN), on collateral development in a repetitive coronary artery occlusion model in rats. METHODS:Coronary collateral growth was induced via a repetitive occlusion protocol (ROP) of the left anterior descending coronary artery (LAD) in rats. The primary endpoints were the histological evaluation of rat heart infarct size and ST-segment elevation (ECG-analysis) upon final permanent occlusion of the LAD (experimentally induced myocardial infarction). The effects of NTG or ISDN were also evaluated by administration during 5 days of ROP. We additionally investigated whether concomitant application of NTG can compensate for the anti-arteriogenic effect of acetylsalicylic acid (ASA). RESULTS:After 5 days of ROP, the mean infarct size and degree of ST-elevation were only slightly lower than those of the SHAM group; however, after 10 days of the protocol, the ROP group displayed significantly less severe infarct damage, indicating enhanced arteriogenesis. Intermittent NTG application greatly decreased the ST-elevation and infarct size. The ISDN also had a positive effect on arteriogenesis, but not to the same extent as the NTG. Administration of ASA increased the infarct severity; however, concomitant dosing with NTG somewhat attenuated this effect. CONCLUSION:Intermittent treatment with the short-acting NTG decreased the size of an experimentally induced myocardial infarct by promoting coronary collateral development. These new insights are of great relevance for future clinical strategies for the treatment of occlusive vascular diseases

A novel computer-aided diagnostic approach for detecting peripheral arterial disease in patients with diabetes

<div><p>Peripheral arterial disease (PAD) is an important manifestation of systemic atherosclerosis, with diabetes being one of its most significant risk factors. Owing to medial arterial calcification (MAC), the ankle–brachial index (ABI) is not always a reliable tool for detecting PAD. Arterial Doppler flow parameters, such as systolic maximal acceleration (ACCmax) and relative pulse slope index (RPSI), may serve as effective surrogates to detect stenosis-induced flow alteration. In the present study, ACCmax and RPSI were prospectively evaluated in 166 patients (304 arteries) with clinical suspicion of PAD, including 76 patients with and 90 patients without diabetes. In the overall sample, the sensitivity of ACCmax (69%) was superior to that of ABI (58%) and RPSI (56%). In patients with diabetes, the sensitivity of ACCmax (57%), ABI (56%) and RPSI (57%) were similar, though a parallel test taking both ACCmax and RPSI into account further increased sensitivity to 68%. The specificity (98%) and accuracy (78%) of ACCmax were superior to those of ABI (83% and 70%, respectively), as were the specificity (95%) and accuracy (77%) of RPSI in patients with diabetes. The diagnostic properties of ACCmax and RPSI were superior to those of ABI for detecting PAD in patients with diabetes. Our acceleration algorithm (Gefäßtachometer^®) provides a rapid, safe, noninvasive tool for identifying PAD in patients with diabetes.</p></div

Comparison of the diagnostic sensitivity, specificity, and accuracy of the parallel test and ABI methods in patients with diabetes (limbs = 160) and in those without diabetes (limbs = 150).

<p>ABI, ankle-brachial index.</p

Baseline characteristics of study participants, stratified by presence/absence of diabetes.

<p>Baseline characteristics of study participants, stratified by presence/absence of diabetes.</p

Comparison of hemodynamic values between different waveform subgroups from all patients.

<p>A) Comparison of ACCmax values between different waveform subgroups. B) Comparison of RPSI values between different waveform subgroups. C) Comparison of ABI values between different waveform subgroups. I: physiological; II: fine monophasic; III: weak monophasic; IV: weak monophasic with diastolic forward flow. ***p < 0.001.</p