Prasugrel versus Clopidogrel for Acute Coronary Syndromes without Revascularization

peer reviewedBACKGROUND: The effect of intensified platelet inhibition for patients with unstable angina or myocardial infarction without ST-segment elevation who do not undergo revascularization has not been delineated. METHODS: In this double-blind, randomized trial, in a primary analysis involving 7243 patients under the age of 75 years receiving aspirin, we evaluated up to 30 months of treatment with prasugrel (10 mg daily) versus clopidogrel (75 mg daily). In a secondary analysis involving 2083 patients 75 years of age or older, we evaluated 5 mg of prasugrel versus 75 mg of clopidogrel. RESULTS: At a median follow-up of 17 months, the primary end point of death from cardiovascular causes, myocardial infarction, or stroke among patients under the age of 75 years occurred in 13.9% of the prasugrel group and 16.0% of the clopidogrel group (hazard ratio in the prasugre

Estimation of global left ventricular function from the velocity of longitudinal shortening

AIMS: To determine if global ventricular function can be assessed from the long-axis contraction of the left ventricle, we compared pulsed-wave Doppler myocardial imaging of mitral annular motion to radionuclide ventriculography. METHODS AND RESULTS: We studied 51 patients (56 +/- 10 years, 11 women) with a radionuclide ejection fraction of 52 +/- 13% (15%-70%). Peak systolic velocities of medial and lateral mitral annular motion correlated with ejection fraction (0.55 and 0.54, respectively; P or = 50%) from abnormal ( or = 8 cm/sec for the medial (sensitivity 80%, specificity 89%) or lateral (sensitivity 80%, specificity 92%) mitral annulus. CONCLUSION: Global left ventricular function can be estimated by recording mitral annular velocity. The implementation of a cutoff limit of 8 cm/sec gave a simple guide for differentiating between normal and abnormal left ventricular systolic function that might be useful clinically in patients without regional wall-motion abnormalities. However, in patients with important segmental wall-motion abnormalities during systole, left ventricular longitudinal shortening is an imperfect surrogate for ejection fraction

Mechanisms of reduction of mitral regurgitation by cardiac resynchronization therapy

We sought to investigate the effects of improved left ventricular (LV) synchrony on secondary mitral regurgitation in patients receiving cardiac resynchronization therapy for severe heart failure

Synergistic Antioxidant Activity and Enhanced Stability of Curcumin Encapsulated in Vegetal Oil-Based Microemulsion and Gel Microemulsions

Curcumin, due to its antioxidant, antibacterial, anti-inflammatory, and antitumoral activity, has attracted huge attention in applications in many fields such as pharmacy, medicine, nutrition, cosmetics, and biotechnology. The stability of curcumin-based products and preservation of antioxidant properties are still challenges in practical applications. Stability and antioxidant properties were studied for curcumin encapsulated in O/W microemulsion systems and three related gel microemulsions. Only biodegradable and biocompatible ingredients were used for carriers: grape seed oil as oily phase, Tween 80, and Plurol® Diisostearique CG as a surfactant mix, and ethanol as a co-solvent. For the gel microemulsions, water-soluble polymers, namely Carbopol® 980 NF, chitosan, and sodium hyaluronate were used. The influence of UVC irradiation and heat treatment on the degradation kinetics of curcumin in the formulations was studied. Because of the antioxidant character of the microemulsion oily phase, the possibility of a synergistic effect between grape seed oil and curcumin was explored. In this study, the high efficiency of the studied drug delivery systems to ensure protection from external degradative factors was confirmed. Also, the influence of the encapsulation in microemulsion and derived gel microemulsion systems on the antioxidant capacity curcumin was studied, and a synergistic effect with vegetal oil was demonstrated

Reversal of subclinical left ventricular dysfunction by antihypertensive treatment: a prospective trial of nebivolol against metoprolol

Objectives: To assess the effects of antihypertensive treatment on subclinical left ventricular dysfunction and to compare the effects of nebivolol with metoprolol. Methods: This is a prospective, randomized, parallel, active-controlled, PROBE design study (ClinicalTrials.org: NCT00942487) in 60 patients (53 ± 9 years, 67% men) with arterial hypertension, left ventricular hypertrophy, normal ejection fraction, and no coronary heart disease, randomized to either a nebivolol-based or a metoprolol-based treatment, who had conventional and tissue Doppler echocardiography, at rest and during dobutamine stress, at baseline and after 6 months. Results: SBP and DBP, and resting heart rate decreased by 13, 13, and 12%, respectively, on nebivolol, and by 11, 13, and 7%, respectively, on metoprolol (all, P < 0.01). Mean longitudinal early diastolic velocity increased by 16% (P < 0.05) on nebivolol compared with 9% (P = not significant) on metoprolol (P = not significant for intergroup differences), whereas flow propagation velocity increased by 34% on nebivolol (P < 0.05) and did not change on metoprolol (P < 0.01 for intergroup differences). Mean longitudinal displacement increased by 10% on nebivolol (P < 0.05) and did not change on metoprolol (P < 0.05 for intergroup differences), whereas ejection time increased by 5% on nebivolol (P < 0.05) and did not change on metoprolol. All the other parameters of left ventricular function were not different between the two treatment arms. Conclusion: Patients with mild-to-moderate hypertension have a beneficial effect from 6-month antihypertensive treatment on diastolic longitudinal left ventricular function; effects are significant with nebivolol, but not with metoprolol