Cardiological evaluation of patients with a cerebral ischemic event: the relation between heart and brain

In this study several aspects of the cardiological evaluation of patients with cerebral ischemia are described; its usefulness for diagnosis and treatment is discussed. The aim of this thesis is to approach the clinical and epidemiological aspects of patients with cerebral ischemic events, while recogoizing the existence of beanbrain interactions in atherosclerotic disease [22]. The general idea is that the organism shonld be considered as a whole; the philosophical term for this idea is 'holism' [23, 24, 25]. In biology the holistic idea can be confirmed by the existence of generalized diseases such as atherosclerosis [26, 27, 28]. A cerebral ischemic event can be considered as a 'Gestalt'. 1bis 'Gestalt' consists of a figure and a background [21]. In the figure the special or local relationship of atherosclerosis with one patt of the organism is expressed: in cerebral ischemia the brain is the affected organ. The figure, however, may never be considered apatt from its background. In brain ischemia, the background is formed by atherosclerosis existiog in the whole organism; coronary sclerosis is pan of this background. The extent to which the specific or local charaCter of an event manifests itself, depends on the influence of the local event on the phenomenon as a whole and vice vers

Evaluation of heart function by Tissue Velocity and Strain (rate) Imaging.

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Improved neurocognitive functions correlate with reduced inflammatory burden in atrial fibrillation patients treated with intensive cholesterol lowering therapy

Contains fulltext : 119310.pdf (publisher's version ) (Open Access)BACKGROUND: Atrial fibrillation (AF) is associated with increased mortality and morbidity, including risk for cerebral macro- and microinfarctions and cognitive decline, even in the presence of adequate oral anticoagulation. AF is strongly related to increased inflammatory activity whereby anti-inflammatory agents can reduce the risk of new or recurrent AF. However, it is not known whether anti-inflammatory therapy can also modify the deterioration of neurocognitive function in older patients with AF. In the present study, older patients with AF were treated with intensive lipid-lowering therapy with atorvastatin 40 mg and ezetimibe 10 mg, or placebo. We examined the relationship between neurocognitive functions and inflammatory burden. FINDINGS: Analysis of inflammatory markers revealed significant reductions in high sensitivity C-reactive protein (hs-CRP), fibroblast growth factor (FGF), granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-1 receptor antagonist (IL-1RA), interleukin (IL)-9, IL-13 and IL-17, and interferon-gamma (IFNgamma) in the treatment group compared to placebo. Reduction in plasma concentration of IL-1RA, IL-2, IL-9 and IL-12, and macrophage inflammatory protein-1beta (MIP-1beta) correlated significantly with improvement in the neurocognitive functions memory and speed. Loss of volume in amygdala and hippocampus, as determined by magnetic resonance imaging (MRI), was reduced in the treatment arm, statistically significant for left amygdala. CONCLUSIONS: Anti-inflammatory therapy through intensive lipid-lowering treatment with atorvastatin 40 mg and ezetimibe 10 mg can modify the deterioration of neurocognitive function, and the loss of volume in certain cerebral areas in older patients with AF. TRIAL REGISTRATION CLINICAL TRIALSGOV: NCT00449410

Increased central venous pressure in a patient with pruritic skin lesions.

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Atrial fibrilation: the relation between heart and brain.

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De behandeling van atriumfibrilleren

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Highly sensitive cardiac troponin T and long-term mortality in a population of community-derived perimenopausal women: nested case-control study

Contains fulltext : 119298.pdf (publisher's version ) (Closed access)OBJECTIVE: To assess the association between baseline levels of highly sensitive cardiac troponin T (hs-cTnT) and long-term mortality in perimenopausal women of the general community using a gender specific 99th percentile reference limit. DESIGN: Nested case control. SETTING: The present study was conducted within the Eindhoven Perimenopausal Osteoporosis Study which is a large prospective cohort of 8503 community-derived women of the city of Eindhoven, The Netherlands. PARTICIPANTS: Cases were defined as Eindhoven Perimenopausal Osteoporosis Study participants who provided an adequate baseline blood sample and subsequently experienced death during follow-up between 1994 and 2003. In total, 123 cases were identified. For each case two matched controls were selected using age, body mass index and hypertension as matching factors. The gender specific 99th percentile reference limit determined in the 246 controls was 8.0 ng/l. MAIN OUTCOME MEASURE: All cause mortality. RESULTS: Hs-cTnT was significantly higher in the cases: 3.0 ng/l versus 2.3 ng/l (p=0.04). After adjustment for matching and clinical risk factors, each 1 SD increase of the level of hs-cTnT was significantly associated with mortality (OR 1.3, 95% CI 1.1 to 1.7, p=0.018). With amino-terminal pro-B-type natriuretic peptide (NT-proBNP) in the multivariable model as a continuous variable the association of hs-cTnT with mortality was lost. With both hs-cTnT and NT-proBNP as dichotomous variables, the gender specific 99th percentile reference limit (8.0 ng/l) was associated with mortality, independent of NT-proBNP (OR 3.7, 95% CI 1.0 to 13.2, p=0.048). CONCLUSIONS: In this study of community-derived perimenopausal women, hs-cTnT was associated with long-term mortality, independent of clinical risk factors. With the use of easily applicable cut-off levels, the gender specific reference limit of hs-cTnT had a prognostic impact that was independent of NT-proBNP