Pulse wave analysis measurements: important, underestimated and undervalued parameters in cardiovascular health problems.

Background: Central aortic stiffness is established as a reliable measure of cardiovascular disease. While pulse wave velocity (PWV) analysis measures arterial distensibility, risk profile of cardiovascular diseases can be expanded with following pulse wave analysis measurements: central aortic systolic blood pressure (CABPS), central aortic pulse pressure (CAPP), central aortic reflection magnitude (CARM), central aortic augmented pressure (CAAP) and central aortic augmentation index (CAAIx). The aim of this study is to evaluate the clinical usefulness and importance of pulse wave analysis measurements in specific cardiovascular conditions and diseases, both in term of diagnosis and therapeutic monitoring. Methods: One thousand sixty-six subjects were included. According to age bracket, four cohorts were investigated-healthy subjects (NL), hypertensive patients (HP), ischemic heart disease (IHD) and valvular heart disease (VHD) patients. Arterial stiffness was analyzed through Sphygmocor XCEL Central Blood Pressure Measurement System and Sphygmocor XCEL PWV Measurement System. Furthermore we observed the pulse wave analysis measurements of 14 patients with diagnose of ADHD who were referred by a child psychiatrist, in order to investigate the initiation of methylphenidate treatment. Results: Statistically significant differences were found between NL and HP cohorts, across almost all age brackets, regarding pulse wave analysis measurements. In the risk stratification of arterial stiffness hypertension and especially central aortic blood pressure systolic (CABPS) seems a determining factor. Pulse wave analysis measurements for IHD and VHD cohort comparisons with NL counterparts, revealed non- statistically significant variations. Elevated CAAP, CAAIx and CARM within the youngest age group (0-10 years) in attention-deficit-hyperactivity-disorder (ADHD) patients warrant attention. Conclusions: Following such investigations, CABPS appears as a robust predominant factor in problems of arterial stiffness. Pulse wave analysis and PWV are important parameters in the evaluation and monitoring of arterial hypertension and cardiovascular diseases. There is a hypothesis that CAAP could be an important and even decisive parameter in the diagnosis of ADHD. Further investigation needed.

Importance of strain imaging in cardiac rehabilitation.

Cardiac rehabilitation improves the subjective condition of the patient; but are there associated structural and functional cardiac adaptations? The study group consisted of 39 patients with an inferior infarction and 21 patients with an anterior infarction, treated by surgical revascularization followed by 4 months of cardiac rehabilitation. Maximal exercise testing and Doppler echocardiography were performed before and after the rehabilitation program. Performance capacity was significantly improved after cardiac rehabilitation, but left ventricular function remained unchanged on Doppler imaging. Only by analyzing the subgroups using strain imaging significant differences were noted after cardiac rehabilitation: patients with an inferior infarction exhibited improved strain values in the anterior wall; those with an anterior infarction had improved strain values in the inferior wall. Strain values in the infarcted regions were worse after cardiac rehabilitation. Strain imaging indicated that cardiac rehabilitation could bring about improvements in cardiac function exclusively in the healthy non-infarcted myocardium, while there were signs of further deterioration of myocardial function in the highly ischemic zones.

Symptomatic atraumatic dissection of a left internal mammary artery graft five years after coronary artery bypass graft surgery.

The case of a spontaneous dissection of a left internal mammary artery grafted on to the diagonal branch and the left anterior descending artery is reported. The clinical and diagnostic features of this condition are discussed. Despite an extensive literature search, no such case was found. The present case is the first to be reported. It was speculated that extensive kinking of the left internal mammary artery contributed to the pathogenesis of this syndrome.

Thrombosis of a patent foramen ovale closure device: thrombolytic management.

Transcatheter closure of a patent foramen ovale (PFO) offers a valuable alternative to surgery in selected patients with presumed paradoxical embolism. Like for all other devices, several complications have been described. Although the majority of these complications are caused by technical problems of the device itself, thrombosis is a relatively infrequent but feared finding, as it may result in recurrent embolic events and persistent neurological deficits. The majority of the complications after implantation are dealt with by surgical removal of the device and subsequent surgical closure of the PFO. The present case report describes biatrial thrombosis of a PFO device that was successfully treated with thrombolytics and GP IIb/IIIa receptor blockers. In stable patients, this pharmaco-therapeutic approach should be attempted to save the thrombosed PFO device and could therefore offer a valuable alternative to surgical removal of the device.

Intoxication with taxus baccata: cardiac arrhythmias following yew leaves ingestion.

The use of yew leaves (Taxus Baccata) as a means of deliberate self-harm is infrequent. The potent effect of the toxin is primarily cardiac and results in rhythm alterations and ultimately ventricular fibrillation. As there is no known antidote, and classic antiarrhythmic therapy proves to be ineffective, a prompt diagnosis is of great importance as immediate supportive action is the only valuable alternative. This case describes a 43-year-old women who attempted suicide by ingesting the leaves of Taxus Baccata. We discuss the effects and the difficulty of treatment associated with yew leaf poisoning.

The 'CARFEM' vascular index as a predictor of coronary atherosclerosis.

BACKGROUND: The purpose of the study was detection of coronary atherosclerosis and identification of persons at risk by means of non-invasive examination of the carotid and peripheral arteries. MATERIAL/METHODS: Investigation of 366 patients: 229 males and 137 females divided into groups according to age and the severity of the coronary atherosclerotic lesions. Only patients with a coronary stenosis of more than 90%, who needed angioplasty or coronary bypass surgery, were included. Group I consisted of patients with normal coronary arteries; Group II, critical one-vessel disease; Group III, two-vessel disease; Group IV, critical three-vessel disease. By means of a vascular duplex scan we measured bilaterally the intima-media thickness of the posterior wall of the common carotid artery. In order to provide a more accurate estimation of the total atherosclerotic burden we have created the 'CARFEM' index (combination index of intima media thickness of carotid artery and total wall thickness of the superficial femoral artery). RESULTS: The anthropometric data were identical among the different groups. There are statistically highly significantly differences in the intima-media thickness of the common carotid artery when patients with normal coronary arteries are compared with patients with three-vessel coronary disease. By calculating the 'CARFEM' index not only we can differentiate between patients with normal coronary arteries and patients with critical three-vessel disease, but there are also ways to differentiate between different subgroups and to assess possible one-vessel, two-vessel or three-vessel coronary artery disease. CONCLUSIONS: The determination of the intima-media thickness of the common carotid artery clearly enables us to detect possible coronary atherosclerosis and to predict its severity in a non-invasive way. The combined assessment of the carotid and the femoral arterial walls permits us to make a distinction between the different subgroups, divided according to the severity of the underlying coronary atherosclerosis.