Metabolic syndrome, inflammation and atherothrombosis.

Extensive research of the past decades altered our traditional concept about the genesis of atherosclerosis fundamentally. Today, the crucial role of inflammation in the formation and progression of atherosclerotic plaques is indisputable. Patients at high risk for developing cardiovascular disease, owing to poor diet, obesity and low physical activity have been shown to exhibit a particular inflammatory pattern. Therefore, the present review highlights the crosslink between the metabolic syndrome (MetS), adipose tissue, adipokines and selected inflammatory cytokines in the context of atherothrombosis and cardiovascular disease.

[Transthoracic recording of pulmonary venous flow for diagnosis of high pulmonary capillary wedge pressure]. / Transthorakale Registrierung des Lungenvenenflusses zur Diagnose eines hohen Pulmonalkapillar-Druckes.

69 patients (46 men, 23 women, age 34 to 78 mean 56 years, all in sinus rhythm) with suspected cardiac insufficiency underwent transthoracic Doppler echocardiography followed by hemodynamic measurement of the pulmonary capillary wedge pressure (= PCP). The echocardiographic measurements included: 1) the peak systolic (S) and diastolic (D) pulmonary venous flow (PVF) velocity (all patients); 2) the E and A peak velocity (62 patients) and 3) the deceleration time (DT, 57 patients) of the mitral flow curve (mean values from 5 to 15 beats). PCP was high (> or = 15 mm Hg) in 27 patients and low (< or = 14 mm Hg) in 42. There were significant correlations between the PCP and all 3 echo parameters: (PCP-S/D: r = -0.69, PCP-E/A: r = 0.66 PCP-DT: r = -0.48, p < 0.05 for all correlations). The sensitivity, specificity, positive and negative predictive accuracy of a pulmonary venous S/D ratio < 1.0 for detecting a high PCP were 82, 83, 76 and 88% respectively, which is similar to the results of previous transesophageal studies. However, slightly reduced S/ID ratios (0.8 to 0.99) were often associated with a normal PCP, and only ratios below 0.8 should be considered as indicative of a high PCP. The mitral flow parameters E/A > or = 1.5 and DT < or = 0.12 s were equally useful in detecting a high PCP: sensitivity, specificity, positive and negative predictive accuracy were 68 and 86, 90 and 80%, 79 and 73%, 84 and 90% respectively. However, E/A ratios between 1.0 and 1.49 were not very useful, representing a high PCP in one third of the cases. There were significant correlations and a high degree of agreement in predicting a high or low PCP between the three Doppler echo parametes, particularly between S/D and E/A ratios. The analysis of pulmonary venous flow by transthoracic echocardiography is a useful method for the non-invasive detection of a high PCP. However, this method no more accurate than the much simpler analysis of mitral flow. The application of the pulmonary venous flow method is indicated when mitral flow cannot be interpreted, for example because of tachycardia, aortic incompetence or an E/A ratio in the ambiguous range (1.0 to 1.49).

[Pseudo-abnormal venous lung blood flow in trained endurance athletes]. / Pseudo-abnormer Lungenvenenfluss bei trainierten Ausdauersportlern.

Pulmonary venous flow was recorded by transthoracic pulsed Doppler echocardiography in 10 endurance trained male athletes and in 10 age matched sedentary male controls. The ratio of peak systolic (S) to peak diastolic (D) flow velocity was much lower in athletes than in controls (0.8 +/- 0.22 vs. 1.13 +/- 0.37 p < 0.05). 5 out of 10 athletes had values less than 0.82 which was the lowest value in the control group. Athletes also hat significantly higher mitral flow E/A ratios and lower heart rates. Physical fitness caused by endurance training should be acknowledged one of the causes for an abnormally low S/D ratio.

[Transesophageal echocardiography in non-rheumatic atrial fibrillation: a moderately sensitive method for assessment of risk of cerebrovascular complications]. / Transösophageale Echokardiographie bei nicht-rheumatischem Vorhofflimmern: eine mässig sensitive Methode zur Abschätzung des Risikos zerebrovaskulärer Komplikationen.

120 consecutive unselected patients with chronic non-rheumatic atrial fibrillation without anticoagulant therapy were examined by transthoracic and transoesophageal echocardiography. Patients with a history of an ischaemic cerebrovascular event (n = 4) had left atrial thrombi, spontaneous contrast or both significantly more often (n = 25, 61%) than patients in the control group (24/79 = 30%). However, when compared with controls, patients with a history of cerebrovascular events were also older, and had hypertension and left ventricular disease (ejection fraction < 45%) more often. Abnormal carotid duplex scans were also very common in this group (71%). Transoesophageal echocardiography is useful for evaluating the risk of cerebrovascular complications in non-rheumatic atrial fibrillation. However, the method is quite insensitive (61%) and therefore insufficient as the sole parameter for deciding the need for anticoagulation. It is likely that cerebrovascular complications in these polymorbid patients are partially caused by other factors than embolism from the left atrium.

Late effect of tobanum and tobanum + furosemide therapy on the glucose tolerance of patients and on the insulin response to oral glucose doses.

The authors examined the effect of beta-blocker monotherapy (Tobanum tab = 5 mg cloranololum hydrochloricum) and beta-blocker + diuretic (Tobanum + Furosemide) combination therapy on glucose tolerance and insulin secretion in response to oral glucose doses in hypertensive non-diabetic patients. Twenty-six patients were examined (13 men, 13 women). The patients were followed up for 28 weeks after a 2-week drug-free period. The hypotensive dose was adjusted individually within 4 weeks. Oral glucose tolerance test and immuno-reactive insulin determination were performed concurrently before starting hypotensive therapy and on weeks 6, 14, and 28 of therapy. The results of the examinations were evaluated separately in two patient groups. Fifteen patients were given daily 10-20 mg Tobanum (Group I) while 11 patients received daily 10-20 mg Tobanum + 40-80 mg Furosemide (Group II). The glucose area of patients on Tobanum monotherapy did not change, insulin secretion decreased gradually (from 804 to 495 pmol/l). The decrease was significant (p less than 0.05). The glucose area of Tobanum + Furosemide-treated patients increased from 13.2 +/- 3.2 mmol/l to 16.1 + 4.9, the insulin secretion decreased from 1039 + 339 to 706 + 411 pmol/l during therapy (p less than 0.02 and p less than 0.05, resp.). When evaluating the results the decrease of insulin secretion is attributed to Tobanum effect while the deterioration of glucose tolerance may be correlated to the action of Furosemide on extrapancreatic metabolism.

A study of modulated ventricular parasystole by programmed stimulation.

To analyze the phase-dependent sensitivity of the parasystolic pacemaker to nonparasystolic beats, 11 patients with modulated ventricular parasystole were studied using the ventricular extrastimulus method. The intrinsic parasystolic cycle lengths ranged from 1,100 to 1,800 ms. Premature stimuli altered the duration of the parasystolic cycle lengths by amounts that depended on timing of the test impulses within the parasystolic cycles. Premature impulses delivered during the first part of the parasystolic cycles prolonged the parasystolic cycle lengths to 107 to 151% of the intrinsic parasystolic cycle lengths and impulses applied during the second part abbreviated them to 70 to 81% of the intrinsic parasystolic cycle lengths. In 10 patients the accelerating effects were of greater magnitude than the decelerating effects. Transition from the accelerating to slowing phases was progressive or unstable in 9 patients and abrupt in 2. Changes induced by individual stimuli were short-lived and the parasystolic pacemakers returned immediately to their original rates. In 1 patient the biphasic sensitivity of parasystole to premature stimuli was shown to sustain for 21 days.

Severe symptomatic atrioventricular block induced by pilocarpine eye drops.

An 89-year-old man with chronic glaucoma received hourly pilocarpine eye drops for seven hours, when he developed third-degree atrioventricular block with a slow idioventricular escape rate. After discontinuing the pilocarpine, the atrioventricular block gradually disappeared. The site of pilocarpine-related block was most likely within the His-Purkinje system.

The effects of overdrive pacing and lidocaine on atrioventricular junctional rhythm in man: the role of abnormal automaticity.

The effects of overdrive pacing and lidocaine were studied in 22 patients with atrioventricular (AV) junctional rhythms. Based on the responses to cardiac pacing and lidocaine, patients were divided into two groups. AV junctional rhythms in group I (17 patients) were suppressed by overdrive pacing, and their rates were decreased by lidocaine. Lidocaine also prolonged the junctional recovery time in these patients. AV junctional rhythms in group II (five patients) were not suppressed by overdrive pacing. In contrast, the rate increased after overdrive pacing. Lidocaine did not alter the basic cycle lengths or the recovery times of the AV junctional rhythms in this group of patients. The data suggest that AV junctional rhythms in group I were caused by normal automaticity, while those in group II were probably due to abnormal automaticity.

Underdrive suppression of the sinus rhythm in man.

This report demonstrates unusual responses of the sinus rhythm to atrial pacing. The sinus rhythm failed to become manifest when the heart was driven at a rate slower than the inherent sinus rate. Sinus rhythm returned only after termination of underdrive pacing with the recovery time longer than twice the cycle length of the control sinus rhythm. The largest difference between underdrive and sinus cycle lengths measured 600 msec. To the best of our knowledge, underdrive suppression of the sinus rhythm has not been previously reported in man.

Concealed re-entry in the human heart.

The mechanism and electrophysiologic manifestations of concealed re-entry were studied in human electrocardiograms and intracardiac recordings. Previously described patterns of concealed re-entry were documented in 49 patients. In seven cases concealed re-entry was involved in the genesis of Wenckebach periodicity and alternating Wenckebach periodicity in the AV node, and "reversed" Wenckebach periods in the His-Purkinje system. These manifestations of concealed re-entry were not described so far. In five cases re-entry was apparently concealed. Complete (but hidden) circus movement of the supraventricular impulses in these patients were detected by intracardiac recordings and by analysing the effects of echo beats on timing of the subsequent sinus beats. Concealed re-entry of the cardiac impulse is a well-documented electrophysiologic event which explains many common and peculiar manifestations of impulse formation and impulse conduction in the human heart.