Neutrophil-to-albumin ratio: a promising tool for CAD assessment in non-ST elevation AMI.

OBJECTIVE: In the context of coronary artery disease (CAD) pathogenesis, inflammation has emerged as a critical player. This study investigates the potential of the Neutrophil-to-Albumin Ratio (NAR) as a novel biomarker for assessing CAD severity and extension in patients suffering from acute myocardial infarction (AMI) without ST-segment elevation. PATIENTS AND METHODS: We conducted a comprehensive analysis of consecutive patient records (n = 211) from a single center, focusing on individuals diagnosed with non-ST elevation AMI. To gauge CAD severity, we employed Syntax Scores (SS) and examined their correlation with NAR, C-reactive protein-albumin ratio (CRPALB), and the systemic immune inflammation index (SII). Statistical analyses were conducted to establish associations and predictive capabilities. RESULTS: Our analysis revealed a significant correlation between NAR and Syntax Scores (r: .416, p<0.01). Notably, patients with intermediate-high SS exhibited significantly elevated NAR values compared to those in the low SS group [20.86+5.38 vs. 16.41+6.30 (p<0.001)]. Furthermore, NAR outperformed CRPALB, SII, and Neutrophil Percent-to-Albumin Ratio (NPAR) in discriminating CAD severity, as demonstrated by the Receiver Operating Characteristic (ROC) curve analysis (NAR AUC: 0.736; CRPALB AUC: 0.673; SII AUC: 0.660; NPAR AUC: 0.717). CONCLUSIONS: This study underscores the potential of NAR as a robust predictor of CAD severity and extension in non-ST elevation AMI patients. While previous markers, such as CRPALB and SII, are advantageous, NAR's superior predictive capabilities are a valuable addition to the clinician's toolkit, offering enhanced risk assessment for this specific patient subgroup.

[COVID-19 infection-update]. / COVID-19-Infektion ­ Update: Was muss der Gefäßmediziner wissen?

At the end of December 2019 many cases of severe pulmonary inflammation were reported in Hubei Province, China. Nearly all of the affected individuals had had contact to the wet fish market, which was believed to be the source of the novel infection and was closed on 1 January 2020. Subsequently, the Chinese health authorities confirmed that the pathogen was a previously unknown severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which belongs to the Coronaviridae family. The disease was then designated as coronavirus disease 2019 (COVID-19) and rapidly spread initially in Asia and later worldwide. In March 2020 the COVID-19 outbreak was declared a global pandemic by the World Health Organization. At the time of manuscript submission, more than 20 million people were affected by COVID-19, with more than 500,000 deaths worldwide. The article gives a general overview on the novel COVID-19 with a specific clinical focus on vascular involvement. The article is essentially based on the currently available evidence and the experiences of the authors.

Investigation of Immunovascular Polymorphisms and Intersections in Psoriasis.

BACKGROUND: Psoriasis is a chronic, inflammatory skin disease. The etiology of the disease is unknown. It is a polygenic and multifactorial disease, which interacts with genetic and environmental factors. Genetic factors (polymorphism/mutation) can alter the immune system and normal physiologically functioning keratinocytes to pathological or predisposition levels. AIMS: We aimed to investigate psoriasis at a different and novel window by searching for vascular and immunological variations and intersections in psoriasis. We investigated the main vascular and hypoxic controlling factors, which are vascular endothelial growth factor (VEGF) and hypoxia inducible factor 1 alpha (HIF-1α), as well as immunological and serotonergic factors, such as TNF-α, IL-10, and 5HT2A, which could connect each other to the pathogenesis of psoriasis. SUBJECTS AND METHODS: Nine single nucleotide polymorphisms (SNPs) in five genes were genotyped by mini-array format in 300 subjects: VEGF (rs2010963, rs833061, and rs1570360), HIF-1α (rs11549465), TNF-α (rs361525, rs1799964, and rs1800629), IL-10 (rs1800896), and 5HT2A (rs6311). RESULTS: An association was found between rs1800629 (TNF-α) and Type I psoriasis, and rs833061 (VEGF) and Type II psoriasis. Haplotype analysis suggests that the coexistence of the polymorphisms rs1799964 (TNF-α), rs2010963 (VEGF), rs833061 (VEGF), and rs6311 (5HT2A) may be a protective factor for psoriasis. CONCLUSION: Our results suggest that the vascular component of the studied vasculo-immunologic variation is more relevant in the pathogenesis of psoriasis.

Inhibitors of energy metabolism interfere with antibiotic-induced death in mycobacteria.

Energy metabolism has recently gained interest as a target space for antibiotic drug development in mycobacteria. Of particular importance is bedaquiline (Sirturo), which kills mycobacteria by inhibiting the F1F0 ATP synthase. Other components of the electron transport chain such as the NADH dehydrogenases (NDH-2 and NdhA) and the terminal respiratory oxidase bc1:aa3 are also susceptible to chemical inhibition. Because antituberculosis drugs are prescribed as part of combination therapies, the interaction between novel drugs targeting energy metabolism and classical first and second line antibiotics must be considered to maximize treatment efficiency. Here, we show that subinhibitory concentration of drugs targeting the F1F0 ATP synthase and the cytochrome bc1:aa3, as well as energy uncouplers, interfere with the bactericidal potency of isoniazid and moxifloxacin. Isoniazid- and moxifloxacin-induced mycobacterial death correlated with a transient increase in intracellular ATP that was dissipated by co-incubation with energy metabolism inhibitors. Although oxidative phosphorylation is a promising target space for drug development, a better understanding of the link between energy metabolism and antibiotic-induced mycobacterial death is essential to develop potent drug combinations for the treatment of tuberculosis.

[A case of cardiac AA amyloidosis]. / AA-Amyloidose mit kardialer Beteiligung.

HISTORY AND CLINICAL FINDINGS: A 51-year-old woman was referred for kidney transplant evaluation. An HIV infection had been diagnosed ten years ago, viral load being negative at present. Renal type AA-amyloidosis was demonstrated by kidney biopsies. The patient had no symptoms. Clinical examination revealed no significant abnormalities with exception of a systolic murmur. A 12-channel electrocardiogram demonstrated peripheral low voltage. Echocardiography showed severe diastolic dysfunction, ventricular hypertrophy and biatrial dilatation. In addition, the aortic valve displayed a calcified mass. TREATMENT AND COURSE: Treatment with an ACE-inhibitor for diastolic heart failure was continued, and the patient was included into the renal transplantation program. CONCLUSIONS: Amyloidosis is characterized by an abnormal folding of certain proteins and their extracellular deposition in several organs. This leads to corresponding dysfunction and can result in organ failure. Cardiac involvement is usually associated with immunoglobulin-light-chain (AL) - or familial transthyretin-associated (ATTR) - amyloidosis and indicates a poor prognosis. This report demonstrates a rare case of pronounced cardiac manifestation of the amyloid protein A (AA) - amyloidosis.

[Apixaban: pharmacology and action profile]. / Apixaban: Pharmakologie und klinisches Wirkprofil.

Vitamin K antagonists are currently the most frequently used anticoagulants. However, practical limitations of their application, such as variability in dose response, a narrow therapeutic index and numerous drug and dietary interactions, have lead to development of new oral anticoagulants with better efficacy and safety profile. Recent advances included the development of orally active FXa inhibitors rivaroxaban and apixaban. Rivaroxaban received its marketing approval in September 2008. Apixaban has recently been approved for prevention of venous thromboembolism after total hip or knee replacement. This review describes the pharmacological properties of apixaban and discusses the latest findings from clinical trials.

[Validation of patients' knowledge after informed consent prior to coronary angiography]. / Überprüfung des Patientenwissens nach Aufklärung vor invasiver Koronarangiographie.

BACKGROUND AND OBJECTIVE: The informed consent of the patient is required before any medical intervention can be done. The impact of the provided information on the subsequent knowledge of the patient is regularly questioned. In the present investigation we aimed to determine the knowledge of the patients about invasive coronary angiography (CA) after they had been optimally vs. standard vs. not at all informed. PATIENTS AND METHODS: 300 consecutive patients who were admitted for planned CA were included. Of these, 150 in-patients were informed by especially trained physicians one day before CA and 50 out-patients were informed by their general practitioner or cardiologist several days before admission. 100 in-patients were included before they were informed. In a standardized interview the predefined knowledge of the patients was assessed by an independent physician before CA in previously informed patients and after hospital admission in non-informed patients. RESULTS: The differences in knowledge between informed in- and out-patients were low. Especially their knowledge about potential complications was not different. Generally, patients could remember less serious complications better than life-threatening ones. Two previously informed patients (1 %) affirmed that they were not informed. The knowledge of non-informed patients was much lower than the knowledge of patients who had been informed. CONCLUSION: The knowledge and remembrance of patients after having detailed information about medical interventions is limited. Optimization of the informative interview did not really improve this knowledge. In contrast to non-informed patients the provided information did, however, increase the knowledge.

[Natriuretic peptides in the therapy of acute decompensated heart failure]. / Akut dekompensierte Herzinsuffizienz: klinischer Stellenwert einer Therapie mit natriuretischen Peptiden.

Heart failure is the most frequent cause of hospitalization in elderly population. Unlike the therapy of congestive heart failure, there was only a modest progress in the medical treatment for acutely decompensated heart failure over the past several decades. Moreover, current treatment is associated with many limitations in clinical practice. The family of natriuretic peptides consists of several structurally similar polypeptides (ANP, BNP, CNP, urodilatin, DNP). ANP and BNP are the most characterized substances and represent an important compensatory mechanisms in heart failure because of their vasodilatory, natriuretic and antiproliferative effects. Nesiritide is a recombinant human BNP which has been shown to be effective in treating heart failure in several clinical trials. However, a recent meta-analysis revealed a nesiritide-associated increased 30-day-mortality rate. The results of initial small-sized trials suggest beneficial hemodynamic effects of urodilatin in decompensated heart failure. Despite of being approved for the treatment of decompensated heart failure in some countries, the clinical relevance of nesiritide is currently unclear. Urodilatin might represent a potential alternative.

[Treatment of pseudoaneurysms by thrombin injection]. / Perkutane Thrombininjektion bei Aneurysma Spurium.

The incidence of pseudoaneurysms after percutaneus arterial procedures is a quite common complication. Ultrasound-guided thrombin injection is an effective and elegant therapy with a low procedural risk, when the physician is trained in the technique. This paper provides a tutorial for physicians including tips and pitfalls.