Effect of Cardiac Function on Cognition and Brain Structural Changes in Dementia

BACKGROUND AND PURPOSE: Cardiovascular risk factors are considered to also be risk factors for dementia. Recent studies have shown that the prevalence of cognitive dysfunction is high in patients with cardiac diseases. However, few studies have investigated the influence of cardiac function on cognition and brain structural changes in dementia. The aims of this study were to determine the relationship between cardiac and cognitive function, and to characterize any structural changes in the brain that could be caused by cardiac function in patients with dementia. METHODS: Dementia patients (n=93) were recruited prospectively with checking for the presence of vascular risk factors such as hypertension. Cognitive function was measured by the Mini-Mental State Examination, modified Mini-Mental State test, and Korean version of the Dementia Rating Scale. Brain magnetic resonance imaging was conducted to evaluate the cerebral white-matter changes (WMC), ventricular dilation, and cortical and hippocampal atrophy. Cardiac function was evaluated using two-dimensional echocardiography. We divided the patients into two groups according to the presence (+) or absence (-) of WMC. RESULTS: In the entire cohort, the size of the left atrium (LA) was positively correlated with the degree of WMC, irrespective of age (p<0.05). The LA was larger in the WMC (+) group (n=42) than in the WMC (-) group. General cognitive function was significantly lower in the WMC (+) group than in the WMC (-) group. Subjects with an enlarged LA tended to exhibit lower cognitive function and more-severe cerebral WMC. CONCLUSIONS: Cardiac dysfunction represented by LA enlargement could be related to cognitive decline and WMC of the brain resulting from impairment of the cerebral hemodynamic process in dementia.

Plasma Inflammatory Markers and T-Lymphocytes Are Activated in Angina Pectoris

BACKGROUND AND OBJECTIVES: Inflammation and activation of immune cells play important roles in the pathogenesis of atherosclerosis. We investigated the activation status of plasma inflammatory markers and immune cells in angina patients. METHODS: We analyzed the plasma level of C-reactive protein (CRP) as a marker of inflammation in 24 patients with angina pectoris (12 unstable angina, 12 stable angina), and 12 normal subjects. The degree of activation of peripheral blood monocytes was assessed by Northern analysis of pro-atherogenic cytokines and the activation status of T-lymphocytes was measured by flow-cytometric analysis of HLA-DR expression on T-cells. RESULTS: Plasma level of CRP was highest in unstable angina patients (1.63+/-0.70 mg/l) and lowest in the control subjects (0.22+/-0.08 mg/l)(p=0.03). We also observed a high correlation between CRP level and the occurrence of minor and major coronary events during 6 months of follow-up. The percentage of HLA-DR positive T-lymphocyte was significantly increased in the unstable angina patients (26.8+/-1.4%) compared with that in the control (14.7+/-1.2%)(p=0.0053). When baseline levels of cytokine mRNA were measured in monocytes, the percentages of the patients expressing higher than normal levels of IL-8, IL-1b, MCP-1, and TF mRNAs was 37.5, 29.2, 33.3, and 37.5%, respectively (p=0.0143, 0.0371, 0.0233, and 0.0143, respectively). Basal mRNA levels of interleukin (IL)-8, tissue factor (TF), IL-1b and monocyte chemoattractant protein-1 (MCP-1) showed a strong correlation with each other (p<0.01 in all combination) but not with tumor necrosis factor (TNF)-alpha or transforming growth factor (TGF)-beta1. CONCLUSION: We observed increase in plasma CRP levels and activation of T-lymphocytes in angina patients. These results may help further classification of angina patients according to the activation of inflammatory markers and understanding the prognosis of the disease.

Comparison of Outcomes between Primary Percutaneous Transluminal Coronary Angioplasty(PTCA) and Thrombolysis with Delayed PTCA in Patients with Acute Myocardial Infarction: Single Center Experience

BACKGROUND AND OBJECTIVES: Many western studies have shown that primary percutaneous transluminal coronary angioplasty (PTCA) may have better clinical result over thrombolytic therapy in patients with acute myocardial infarction. There are, however, few reports about the role of primary PTCA in Korea. We reviewed the cases of primary PTCA and thrombolysis with delayed PTCA in Samsung Medical Center to compare the clinical outcomes of two treatment modalities. MATERIALS AND METHOD: This study was a non-randomized and retrospective trial. From August 1995 to March 1998, 80 AMI patients within 12 hours of symptom onset underwent primary PTCA (n=26) or thrombolytic therapy (n=54) in Samsung Medical Center. Patients who had thrombolysis were performed coronary angiography fourth to fifth hospital day routinely. Risk factors and time to treatment (pain-to-needle time and door- to-needle time) were reviewed from patient record. Angiographic data including TIMI flow were obtained from angiography data base and angiographic film. We compared the 30-day and 8-month event rate of death, re-infarction, re-PTCA, and CABG between two groups. RESULTS: Baseline characteristics (sex, age, blood pressure, heart rate, AMI location, ejection fraction of left ventricle) were similar between two groups. There was no statistically significant difference in pain-to-needle time and door-to-needle time between two groups. The 30-day mortality rate was similar between two groups (primary group 3.8%, thrombolysis 5.6%, p=1.0). The 30-day event rate also showed no difference between two groups (primary PTCA 7.7%, thrombolysis 11.1%, p=1.0) and there was similar tendency in 8-month event rate (primary PTCA 19.2%, thrombolysis 14.8%, p=0.62). However, the admission duration of primary PTCA group was shorter than that of thrombolysis (8.7 vs 12 days, p=0.03). CONCLUSION: Primary PTCA have similar clinical outcome except shorter hospital admission duration when compared to thrombolysis with routine elective coronary angiography and delayed PTCA in AMI patients without cardiogenic shock.

Activation of monocytes, T-lymphocytes and plasma inflammatory markers in angina patients

Inflammation and activation of immune cells have important roles in the pathogenesis of atherosclerosis. We analyzed the plasma levels of inflammatory markers and the degree of activation of peripheral blood monocytes and T-lymphocytes isolated from 12 unstable angina, 12 stable angina, and 12 normal subjects. In 20%-33% of patients, monocytes expressed high basal levels of IL-8, tissue factor, IL-1beta, and monocyte chemoattractant protein-1 mRNA. Furthermore, basal mRNA levels of these cytokines showed strong correlation with each other (p < 0.01 in all combination) but not with tumor necrosis factor-alpha or transforming growth factor-beta1. Plasma level of C-reactive protein was highest in the unstable angina patients (1.63+/-0.70 mg/l) and lowest in the control subjects (0.22+/-0.08 mg/l) (P = 0.03). We also observed a high correlation between C-reactive protein level and the occurrence of minor and major coronary events during 6 months of follow-up. Activation status of T-cells, assessed by the percentage of HLA-DR positive cells, was highest in the unstable angina patients (26.8+/-1.4%) compared with that in the control (14.7+/-1.2%) (P = 0.0053). Our data represent the first case showing that the circulating monocytes in angina patients are activated to a state express numerous proatherogenic cytokines. These results may help to diagnose angina patients according to the inflammatory markers and evaluate the prognosis of the disease.