The prediction of coronary artery disease based on non-invasive examinations and heme oxygenase 1 polymorphism versus virtual histology.

OBJECTIVE: Prediction of coronary atherosclerosis in patients with stable angina based on non-invasive examinations. METHODS: Pro-inflammatory markers, heme oxygenase-1 (HO-1) polymorphism, lipid levels, Framingham risk score (FRS), and carotid ultrasound were analyzed and compared to grayscale and virtual histology intravascular ultrasound (VH-IVUS). RESULTS: A total of 101 patients were included, and genetic analysis was performed on 81 patients (80.2%). The HO-1 risk polymorphism was more frequent in patients post-myocardial infarction (61.3% vs 32%; P=.0097), or with diabetes (68.4% vs 35.5%; P=.011) or a higher FRS (21.5 vs 15.7; P=.014). Plaques in patients with the HO-1 risk polymorphism contained less fibro-fatty tissue (17.1% vs 23.2%; P=.005) and more necrotic core (NC; 17.1% vs 12.7%; P=.02) and calcification (10.2% vs 5.7%; P=.035) compared to patients without the HO-1 risk polymorphism. Carotid intima media thickness (P=.05) and carotid bulb plaque (P=.008) predicted plaque burden. The level of Apo A inversely correlated with NC (P=.047; r = -0.27) and was lower in patients with VH-thin-cap fibroatheroma (VH-TCFA; 1.19 mmol/L vs 1.3 mmol/L; P=.04). FRS correlated with NC (P=.007; r = 0.2), with angiographic disease severity (P=.032; r = 0.21) and was higher in patients with VH-TCFA (9.1 vs 7.8; P=.03). CONCLUSION: Carotid ultrasound and HO-1 polymorphism improve coronary atherosclerosis prediction.

[Deep calf vein thrombosis]. / Flebotrombóza lýtkových zil.

Isolated calf vein thrombosis in the population of patients with deep vein thrombosis is found approximately in 10 to 25 % of cases. We present 3 cases of calf vein thrombosis which occurred due to unusual causes. Specific characteristics of this form of thromboembolic disease are discussed and compared to proximal deep vein thrombosis with emphasis to symptoms, risk of complications, prognosis and therapeutic approach.

[Carotid plaque exulcerated]. / Exulcerovaný karotický plát.

The authors report a case of a 77 years old male patient with mild stenosis of the carotid artery caused by an exulcerated plaque in the carotid bifurcation. The patient presented with recurrent ipsilateral strokes which were treated with intravenous thrombolysis. A brief review of the literature related to the management of unstable exulcerated carotid plaque is presented in this article with emphasis on current treatment options. Carotid endarterectomy if often performed in such cases. However, the outcome of the procedure remains still very controversial. In the described case, conservative approach using optimal medical treatment with lipid lowering agents, antiplatelet and antihypertensive therapy was chosen mainly because of patient preference and resulted in favourable outcome.

Endovascular treatment combined with stratified surgery is effective in the management of venous thoracic outlet syndrome complications: a long term ultrasound follow-up study in patients with thrombotic events due to venous thoracic outlet syndrome.

Thoracic outlet syndrome (TOS) is caused by compression of peripheral nerves and vascular structures along their course through the upper thoracic aperture to the axilla. The aim of our study was to analyze long-term outcomes of different treatments stratified by symptom severity. We performed a retrospective analysis of a cohort of 73 consecutive patients treated at our institution presenting with TOS-associated venous thrombotic events. Treatment strategies and immediate outcome analysis were completed by long-term follow-up with duplex ultrasound controls 6-12 months after the initial clinical event. Conservative therapy was started in mildly symptomatic patients (n = 32), of which 12 required endovascular procedures because of treatment failure. Endovascular treatment was attempted in all highly symptomatic patients and in those with conservative treatment failure (n = 53), of which 12 required acute surgical intervention. Elective surgical treatment was indicated in 30 other patients because of persistent symptoms. Surgery was associated with a significantly lower rate of the ultrasound-detected signs of persisting vascular compression. However, the rate of persisting clinical symptoms was comparable to those treated only by endovascular or conservative therapy. Our data demonstrate that initial endovascular treatment proposed as first line therapy to highly symptomatic subjects and in those with conservative treatment failure improves the symptoms in 77% of patients avoiding the need of acute surgery. Acute and elective surgical decompression leads to lower rates of vascular compression signs without significant amelioration of persisting clinical symptoms as compared to endovascular or conservative therapy.

Effect of preload reduction by hemodialysis on conventional and novel echocardiographic parameters of left ventricular structure and function.

BACKGROUND: Available studies of the effect of hemodialysis (HD) on left ventricular (LV) performance brought ambiguous results. Therefore we aimed to investigate the effect of acute preload reduction induced by HD on conventional and novel parameters of LV structure and function. METHODS: Thirty-six patients underwent echocardiography 1 hour prior to and 1 hour following regular HD. M-mode, two-dimensional, and Doppler echocardiography were used to analyze conventional LV structural and functional parameters. Systolic and diastolic mitral annular velocities assessed by pulsed-wave tissue Doppler echocardiography (PW-TDE) and flow propagation velocity (Vp) of early LV inflow were measured as novel indices of LV systolic and diastolic function. RESULTS: After HD, all heart chambers including LV significantly reduced in their size. The reduction in LV mass was also observed. Parameters of LV systolic function-ejection fraction and systolic mitral annular velocity, significantly improved, whereas fractional shortening did not. As for LV diastolic function, conventional Doppler parameters and Vp were substantially changed after HD. Conversely, PW-TDE diastolic velocities were not significantly affected. CONCLUSIONS: The fluid removal induced by HD leads to a substantial decrease in LV size and mass. The improvement of LV longitudinal contraction documented by PW-TDE seems to be responsible for the increase in global LV systolic function after HD. While standard Doppler parameters of LV diastolic function and Vp are significantly affected by preload reduction, PW-TDE diastolic indices appears to be less load dependent. Therefore, PW-TDE represents a promising method for the LV diastolic function assessment in patients on HD.