ABSTRACT
Chlamydia Pneumoniae [CP] is a common pathogen that has been linked to coronary artery disease. Also, CP antigen has been demonstrated in valve biopsy specimens from patients with acquired aortic valve stenosis and in patients with culture negative endocarditis. The aim of this paper is to study the presence of CP in both aortic and mitral valves by using polymerase chain reaction [PCR] and its relation to the pathology of the valve. 27 patients [16 males] who underwent aortic and mitral valve replacement were studied. Key demographic and clinical data were collected including age , gender , past history of rheumatic fever . NYHA class, preoperative 12 leads ECG. Chest X-ray and Echocardiography. One portion of the valve leaflet was sent for pathologic examination to detect the nature of valve disease e.g. rheumatic or non-rheumatic and the other portion was sent for PCR study. The age ranged from 19 to 55 years with mean valve 36.48 +/- 11.46. 5 patients had isolated aortic valve stenosis , 12 had mitral valve disease and 10 had double valve disease . Aschotf body and cells were seem in 11 patients and 5 patients had non-rheumatic degenerative aortic stenosis . 7 out of 27 cases [25.9%] were PCR positive. 5 of them were isolated non-rheumatic aortic stenosis and represent [33. %] of aortic cases. The remaining 2 PCR positive cases were rheumatic mitral valve disease one of them was severe isolated mitral regurgitation due to native valve endocardifis . CP infection was common with nonrheumatic aortic valves [P=0.045] and also with stenotic lesions than regurgitant ones [P=0.045]. Culture negative endocarditis maybe due to CP infection and also CP maybe present in rheumatic mitral valve most probably as passengers
ABSTRACT
Background: Continuous nitrate therapy leads to complete tolerance within 24 to 48 hours. The mechanism[s] responsible for nitrate tolerance is unclear, but there is increasing evidence that nitroglycerin [NTG] leads to superoxide anion production. Estrogen re-placement exerts a cardioprotective effect in postmenopausal women, one of its beneficial effects is to scavenge superoxide radicals
Objectives: This study sought to evaluate the preventive effect of trasdermal estrogen [TD-E] on the development of nitrate tolerance
Methods: In this double-blind, placebo-controlled study, 30 post-menopausal women with chronic stable angina pectoris [mean age 60 +/- 9 years] were randomized to receive either TD-E patch [delivering 50 mg daily] [estradiol group, n = 15] or placebo [placebo group, n = 15]. The vasodilator response to NTG was assessed by measuring the change in brachial artery diameter before and 5 min after 0.5 mg sublingual NTG, using a high resolution ultrasound. Blood samples were simultaneously obtained to measure serum estradiol levels. Brachial artery study and blood sampling were performed serially at baseline [day 0], 3 days after administration of TD-E or placebo [day 3] and 3 days after application of a 5-mg/bid NTG tape concomitantly with TD-E or placebo [day 6]
Results: There was no significant difference in NTG-mediated dilatation between the placebo group and the estradiol group on day 0 [estradiol group, 22.1 +/- 3.6 %; placebo group, 21.8 +/- 5.7 %] or day 3 [estradiol group 22.8 +/- 3.7 %; placebo group 22 +/- 4.8 %]. On day 6, the NTG mediated dilatation in the placebo group [9.5 +/- 2.4 %] was significantly reduced compared with that on days 0 and 3 [p < 0.01]. By contrast, in the estradiol group, the NTG-mediated dilatation [23.1 + 2.1%] was maintained and significantly greater than that in the placebo group [p < 0.01]. Estradiol maintained also the hemodynamic effect of NTG despite its continuous application
Conclusions: Our findings suggest that TD-E patches attenuate nitrate tolerance in postmenopausal women with chronic stable angina. Although the underlying mechanism has not been determined, the estrogenic antioxidant effects provide an attractive explanation
ABSTRACT
Background: previous studies have demonstrated that vascular endothelial dysfunction is related to the degree and patterns of left ventricular hypertrophy [LVH] in patients with essential hypertension [HTN]. However, it is not clear whether endothelial dysfunction develops with the progression of LV diastolic dysfunction
Objectives: we sought to assess the correlation between endothelial vasodilation and LV diastolic function in essential HTN
Methods: using high-resolution ultrasound, we measured the dilator response of the brachial artery to hyperemia [endothelium dependent vasodilation] and to 0.5 mg nitroglycerin [endothelium independent vasodilation], and measured peak velocities of the early wave [Evmax] and the atrial wave [Avmax] in 100 patients with essential HTN and 20 normal subjects. We analyzed the relationship between the Evmax/Avmax ratio and endothelium-dependent vasodilation
Results: the results showed that endothelium-dependent and endothelium independent vasodilation as well as the Evmax/Avmax ratio was lower in the hypertensive group than those in the control group were [5.2% +/- 1.2%, 1 2.4% +/- 2.1%, 0.8 +/- 0.2 vs. 10.5% +/- 2.4%, 22.2% +/- 3.3% 2.1 +/- 0.29, respectively; P<0.01]. There was a positive significant correlation between Avmax ratio and endothelium-dependent vasodilation [r= 0.58, P<0.01]
Conclusions: our results showed that the development of endothelial dysfunction was associated with the progression of myocardial diastolic dysfunction in patients with essential HTN, which suggests that the same mechanisms may be involved in the impairment of endothelium and myocardium
ABSTRACT
Background: the possibility that cytokines can play a role in the progressive deterioration of left ventricular [LV function has emerged in recent years. To address this issue we 1] further investigated the hypothesis of activation of TNF alpha and IL-6 in patients with congestive heart [failure [CHF], and 2] estimated the clinical and echocardiographic factors for increased of these cytokines in these patients
Methods: we determined serum levels of TNF alpha and IL-6 in 75 consecutive patients with mild and severe CHF and then correlated these data with clinical and echocardiographic variables
Results: both plasma levels of TNF alpha and IL-6 were significantly higher in patients with CHF than in control subjects. On multivariate Cox proportional hazards regression analyses, LV end-diastolic diameter [LVDd] showed independent and significant positive relation [P<0.01], and body mass index [BMI] showed independent and significant negative relation [P<0.01] with plasma TNF alpha levels among 17 clinical and echocardiographic variables. Moreover, LV mass and female gender showed independent and significant positive relations [P<0.01] with the plasma IL-6 levels
Conclusions: our results do not support the hypothesis that increased production of cytokines is only related to the severity of CHF independent of other factors, and suggesting an important role for other clinical and echocardiographic factor-s in cytokine activation in CHF