Crataegus laevigata decreases neutrophil elastase and has hypolipidemic effect: a randomized, double-blind, placebo-controlled trial.

Crataegus laevigata is a medicinal plant most commonly used for the treatment of heart failure and psychosomatic disorders. Based on previous experimental findings, this double-blind placebo-controlled study was aimed at finding beneficial effects of C. laevigata on biomarkers of coronary heart disease (CHD). The study included 49 diabetic subjects with chronic CHD who were randomly assigned to the treatment for 6 months with either a micronized flower and leaf preparation of C. laevigata (400 mg three times a day) or a matching placebo. Blood cell count, lipid profile, C-reactive protein, neutrophil elastase (NE) and malondialdehyde were analyzed in plasma at baseline, at one month and six months. The main results were that NE decreased in the C. laevigata group compared to the placebo group. In the C. laevigata group, baseline figures (median and interquartile range) were 35.8 (4.5) and in the placebo group 31 (5.9). At the end of the study, values were 33.2 (4.7) ng/ml and 36.7 (2.2) ng/ml, respectively; p<0.0001. C. laevigata, added to statins, decreased LDL cholesterol (LDL-C) (mean±SD) from 105±28.5 mg/dl at baseline to 92.7±25.1 mg/dl at 6 months (p=0.03), and non-HDL cholesterol from 131±37.5 mg/dl to 119.6±33 mg/dl (p<0.001). Differences between groups did not reach statistical significance at 6 months. No significant changes were observed in the rest of parameters. In conclusion, C. laevigata decreased NE and showed a trend to lower LDL-C compared to placebo as add-on-treatment for diabetic subjects with chronic CHD.

Clinical scores and patient risk stratification in non-ST elevation acute coronary syndrome.

BACKGROUND: Risk stratification of patients with unstable angina or non-ST-segment elevation myocardial infarction (UA/NSTEMI) is problematic given the heterogeneous presentation of the condition. This study was undertaken to compare, in UA/NSTEMI patients, the prognostic value of two clinical risk scores (RS) (i.e. Thrombolysis in Myocardial Infarction (TIMI) and physician's risk assessment (PRA)) and to assess whether serum biomarkers can increase the prognostic accuracy of these RS. METHODS: We prospectively assessed 610 consecutive UA/NSTEMI patients, 217 (36%) UA and 393 (64%) NSTEMI. In all patients RS, high sensitivity C-reactive protein, CD40 ligand, IL6, IL10, IL18, E-selectin, P-selectin, white blood cell count, neopterin, myeloperoxidase, fibrinogen and NT proBNP were assessed at study entry. The primary study endpoint was death and non-fatal MI at 30 and 360 days of follow-up. RESULTS: At 1 year, 54 patients (8.9%) had reached the primary study endpoint (26 suffered a cardiac death (4.3%) and 34 (5.6%) a non-fatal MI). For both RS, the study endpoint occurred more commonly in patients at a "higher risk" compared to those classified as being at a "lower risk". Moreover, TIMI and PRA RS had similar discriminatory accuracy. TIMI RS, however, was a better predictor of events than PRA at both 30- and 360-day follow-up. The inflammatory biomarkers assessed in the study did not improve significantly the predictive value of RS. CONCLUSIONS: Our study suggests both that TIMI RS is a better marker of risk than PRA RS and inflammatory biomarkers do not increase the predictive value of these clinical risk scores.

Changes in canine ventricular refractoriness induced by trains of subthreshold high-frequency stimuli.

Epicardial electrodes were applied to 12 thoractomized dogs to determine the effects of trains of subthreshold conditioning stimuli (TSc) on ventricular refractoriness when delivered preceding a premature suprathreshold stimulus (S2). Several factors were analyzed: (1) the influence of TSc pulse frequency (100-900 Hz); (2) the delay between TSc and S2 (1 or 10 ms); (3) the distance between the electrodes for the emission of TSc and S2 (same electrodes or different electrodes at 3 mm); and (4) S2 current intensity (two- or fourfold diastolic threshold). The TSc (mean current intensity 0.33 mA, range 0.1-0.7) were found to significantly prolong the effective ventricular refractory period (EVRP) at all train pulse frequencies. The EVRP increment was progressively greater as pulse frequency was increased, the maximum EVRP increment being at 900 Hz (mean 50.8 +/- 32.3 ms; maximum increment 130 ms). On increasing S2 current intensity, the EVRP increment was less (maximum value 35 ms) and less consistent (in four of six dogs); in two cases the EVRP was shortened. The increase in delay between TSc and S2 attenuated the EVRP prolongation, which was present in only three of six dogs tested, and the EVRP was shortened in two dogs. There was no EVRP prolongation at any TSc pulse frequency when TSc and S2 were delivered at different electrodes. Thus TSc decreases myocardial ventricular excitability, prolonging EVRP in direct proportion to TSc pulse frequency. However, this property is limited by S2 current intensity as well as the time and distance between TSc and S2.

Cardiac involvement by non-Hodgkin's lymphoma in acquired immune deficiency syndrome.

Non-Hodgkin's lymphomas are frequent in patients with human immune deficiency virus positive antibodies. Exceptional instances of cardiac involvement have been described. We report a case of non-Hodgkin's lymphoma and massive cardiac involvement with antemortem echocardiographic assessment. Use of echocardiography in lymphomas-associated AIDS could help in discovering further cases of cardiac involvement.

[Experience with dual-chamber pacemakers at the Valencia General Hospital]. / Resultados de la estimulación de doble cámara en el Hospital General de Valencia.

We report our experience with dual chamber pacemakers in 70 patients (mean age 64.5), of whom 42 had AV block and 28 sick sinus syndrome, nine of them associated with AV block. Other cardiac disease coexistent with the conduction disturbance was present in 57% of the patients. Follow-up was conducted after implantation at first, 3rd, 6th month, and thereafter each 6 months. Mean follow-up was 20 +/- 14.3 months (2-72); of the 70 patients, 88% and 73% were followed at least for 6 and 12 months, respectively. Six patients (five had AV block) died 17 months on average after implantation. All patients but one had concomitant cardiac disease. Eleven patients (15.6%) presented complications, being all of them related to atrial channel: reprogramming to VVI in five (7%), mainly due to chronic atrial fibrillation (4 patients), whereas in the other one was secondary to loss of pacing and sensing functions; acute dislocation corrected with reoperation in 3 patients (4.3%); temporary loss of atrial sensing in 2 patients, and chronic in the last one, with change to DVI mode. Overall, considering deaths and changes to VVI mode, 15.6% of patients were not be able to maintain dual chamber pacing. In conclusion, our results show: 1) low rate of major complications; 2) good outcome of patients suffering from sick sinus syndrome; 3) the development of chronic atrial fibrillation was the main limitation of DDD pacing system.