Can vasohibin-1, an endothelium-derived angiogenesis inhibitor, be a marker of endothelial dysfunction in hemodialysis patients?

BACKGROUND: Endothelial dysfunction (ED) is associated with high cardiovascular disease burden in hemodialysis (HD) patients. Vasohibin-1, an endothelium-derived angiogenesis inhibitor, is essential for endothelial cell survival, therefore it may be a promising marker of ED. We aimed to investigate whether vasohibin-1 levels are associated with ED markers in HD patients. METHODS: Fifty HD patients and 30 healthy controls were included in the study. As markers of ED, endothelium-dependent flow-mediated dilatation (FMD), carotid intima-media thickness (CIMT), and pulse wave velocity (PWV) were examined. Serum vasohibin-1 levels were measured with ELISA. RESULTS: Serum vasohibin-1 levels were low (387.7 ± 115.7 vs 450.1 ± 140.1 P = .02), FMDs' were impaired (6.65 ± 2.50 vs 10.95 ± 2.86 P < .001), PWV (7.92 ± 1.964 vs 6.79 ± 0.96 P = .01) and CIMT (0.95 ± 0.20 vs 0.60 ± 0.11 P < .001) were increased in HD patients compared to healthy controls. In regression analysis, vasohibin-1 levels were not related with FMD, PWV, or CIMT. CONCLUSIONS: Hemodialysis patients have low serum vasohibin-1 levels but serum levels of vasohibin-1 did not show any significant relationship with FMD, PWV, and CIMT in HD patients. Since vasohibin-1 acts via paracrine pathways, serum levels may be insufficient to explain the relationship between vasohibin and ED. Local vasohibin-1 activity on tissue level may be more important instead of circulating levels.

Comparison of Ultrasound Guidance and Conventional Method for Common Femoral Artery Cannulation: A Prospective Study of 939 Patients.

BACKGROUND: Many techniques, methods and closure devices have been developed in order to reduce vascular complications that occur after coronary and peripheral interventions. The aim of the present study was to identify which method i.e. ultrasound (US) guidance or traditional access technique, is better for common femoral artery cannulation. METHODS: The study included 939 patients, who were assigned to either the US-guided cannulation group (n = 449) or manual technique group (n = 490). The procedure time, first pass success rate, inadvertent venous puncture rate and complications developing within the first 7 days of the procedure were compared between the two groups. RESULTS: No differences were found between the two groups regarding basic characteristics and antiplatelet and anticoagulant therapy administered during and up to 24 hours before the procedure. Arterial puncture attempts (p < 0.001), inadvertent venous entry (p = 0.02), and total procedure time (p = 0.012) were significantly lower in the US-guided group compared to the manual technique group. Furthermore, the first pass success rate was significantly higher in the US-guided group compared to the manual technique group (p < 0.001). The US-guided group had significantly lower pain levels (p < 0.001), hematomas (p < 0.001) and arteriovenous fistulas (p = 0.011) than the manual technique group. CONCLUSIONS: US-guided common femoral artery cannulation yields both higher access rates at first attempt and a shorter access time, and lower pain and complication rates.

Relation of epicardial fat thickness to subclinical right ventricular dysfunction assessed by strain and strain rate imaging in subjects with metabolic syndrome: a two-dimensional speckle tracking echocardiography study.

BACKGROUND: Right ventricular (RV) function is known to be impaired in the presence of metabolic syndrome (MetS). Epicardial adipose tissue is a metabolically active organ that generates various bioactive molecules, which might affect cardiac function and morphology. Thus, we hypothesized that RV dysfunction in patients with MetS may be related to increased epicardial fat thickness (EFT) in these patients. In patients with MetS, we aimed to assess the relation of EFT with RV function using two-dimensional speckle tracking echocardiography (2DSTE)-derived strain and strain rate imaging. METHODS: The study involved 76 subjects with MetS and 61 subjects without MetS. Biventricular structure and function together with EFT were evaluated by conventional echocardiography. RV free and septal walls strain (RVFW-S & RVSW-S), systolic and early diastolic strain rates (RVSRs & RVSRe) were evaluated by 2DSTE. RESULTS: Epicardial fat thickness was significantly higher in subjects with MetS (6.45 ± 1.48 mm vs. 5.49 ± 1.05 mm, P < 0.001). RVFW-S (-22.95 ± 4.97% vs. -24.96 ± 3.63%; P = 0.007), RVSRs (1.53 ± 0.33/sec vs. -1.70 ± 0.33/sec; P = 0.002), and RVSRe (1.40 ± 0.44/sec vs. 1.75 ± 0.49/sec; P < 0.001) were all lower in subjects with MetS, while RVSW-S did not differ. Multiple regression analysis showed that EFT was independently associated with RVFW-S (ß = -0.547, P < 0.001), RVSRs (ß = -0.332, P = 0.001), and RVSRe (ß = -0.187, P = 0.019) in subjects with MetS. CONCLUSIONS: Metabolic syndrome is associated with subclinical RV systolic and diastolic dysfunction. In subjects with MetS, increased EFT is independently related to RV systolic and diastolic dysfunction.

Clinical outcomes and effectiveness of renal artery stenting in patients with critical atherosclerotic renal artery stenosis: does it improve blood pressure control and renal function assessed by estimated glomerular filtration rate?

INTRODUCTION: Atherosclerotic renal artery stenosis (ARAS) is associated with uncontrolled hypertension and chronic renal failure. AIM: To evaluate the influence of gender and presence of chronic renal failure on the outcomes of percutaneous transluminal renal artery stenting (PTRAS) due to atherosclerosis. MATERIAL AND METHODS: A total of 28 ARAS patients underwent PTRAS and 36 stents were placed. Basal characteristics, laboratory data and blood pressure of patients were recorded. The differences between genders and improvement/deterioration of renal functions and blood pressure were analyzed. The predictors of outcomes were determined. RESULTS: Baseline characteristics were similar between men and women. Significant improvement of systolic and diastolic blood pressure control was achieved after PTRAS (153.04 ±17.07 mm Hg vs. 124.75 ±11.40 mm Hg, p = 0.001 and 92.50 ±10.76 mm Hg vs. 77.54 ±8.23 mm Hg, p < 0.001, respectively). Although mean estimated glomerular filtration rate (eGFR) and creatinine levels did not significantly improve at the 6-month follow-up visit compared to baseline values, of the 28 patients 13 (46.4%) patients had improvement of renal functions. CONCLUSIONS: Our results suggest that PTRAS is a safe procedure and may offer blood pressure control but beneficial effects of PTRAS on renal function may be anticipated in a selected group of patients, especially those with a low eGFR.

Quiste hidatídico cardiaco: un enfoque multimodal / Cardiac cyst hydatid: a multimodality approach

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