Arterial atherosclerosis in patients with chronic kidney disease and its relationship with serum and tissue

We investigated the correlation between atherosclerosis and tissue and serum levels of endothelin-1 in patients with chronic kidney disease [CKD]. Arterial samples were obtained from 35 patients with CKD during arteriovenous fistula placement. Thirty-one patients with cardiovascular disease who underwent coronary artery bypass graft [CABG] were selected as the atherosclerotic group, and a piece of their aorta punched during CABG was obtained. Also, a small piece of the renal artery was dissected during donation in 24 kidney donors [control group]. Tissue endothelin-1 level was measured and atherosclerosis grading was determined by pathologic examination. Serum levels of endothelin-1 were also measured in the three groups. The mean tissue endothelin-1 levels were 10.73 +/- 7.57 pg/ mL, 12.16 +/- 3.95 pg/mL, and 0.93 +/- 1.06 pg/mL in the patients with CKD, those with CABG, and donors, respectively [P < .001]. The mean serum endothelin-1 level was 25.23 +/- 15.15 pg/mL in the patients with CKD, 21.13 +/- 17.22 pg/mL in the patients with CABG, and 2.66 +/- 1.51 pg/mL in the donors [P < .001]. Atherosclerosis grades correlated with tissue endothelin-1 level [r = 0.823, P < .001] and serum endothelin-1 level [r = 0.608, P < .001] in the patients with CKD. Multiple regression analysis showed tissue endothelin-1 level as the main predicting factor of atherosclerosis [P < .001]. Tissue endothelin-1 concentration is more important than serum endothelin-1 or lipids levels in prediction of atherosclerosis. Thus, blockade of tissue endothelin-1 receptors with its antagonists may prevent atherosclerosis progression

national survey of cardiac pacemakers and cardioverter defibrillators

Permanent pacemakers provide effective relief of symptoms and are life-saving in patients with symptomatic heart block. Implantable cardioverter defibrillators [ICD] are also increasingly recognized as life-saving tools in various groups of patients with malignant ventricular tachyarrhythmias. As part of the "world survey on pacemaker and ICD implantations ", A survey of all device implantations in Iran during the year 2001 was performed. Data was collected and cross-checked through three sources i.e. direct contact with implanting physicians, pacemaker companies and the governmental pacemaker distributing body. During the year studied, 1635 patients received permanent pacemakers. 88% were new implants at an estimated rate of 24 per million population. The mean age of patients was 65 years and 56.2% were male. 40 cardiologists and 19 surgeons implanted the pacemakers at 27 centers throughout the country. Complete heart block was consistently the most common indication at all centers [mean 56.1%], sick sinus syndrome being the next most common one [mean 20.8%]. 69% of the pacemakers were single chamber pacemakers. Transvenous insertion of bipolar steroid-eluting passive fixation leads was the predominant practice at most centers. A total of 60 ICDs were implanted at 7 centers by 9 cardiologists. 45% of ICD implants were dual chamber devices. The survey is the only one available right now and provides useful information about the prevailing pacemaker and defibrillator implantation practice in Iran. Future surveys would be facilitated if a standardized implant registry such as that used in Europe were established in this country