[The importance of carotid ultrasound in the risk stratification of patients with ischaemic heart disease]. / Importanta practica a ultrasonografiei carotidiene in stratificarea riscului la pacienti cu cardiopatie ischemica.

UNLABELLED: The stratification of cardiovascular risk is important both in primary and secondary prevention. In the clinical evaluation, besides the well-known risk factors, the European Guide of Cardiovascular Prevention recommends the identification of additional markers of risk, one of them being the detection of atherosclerotic alterations by carotid ultrasound examination. The objectives of this study were: assessment of carotid ultrasound alterations in patients with known cardiovascular disease; their relation with the other risk factors, the clinical status and echocardiography. METHOD: The study included 144 patients, aged 41-80 (84 males, 60 women) with cardiovascular disease (stable angina, myocardial infarction, peripheral arterial disease, arterial hypertension). Risk factors as smoking, hypercholesterolemia, diabetes mellitus, obesity have been determined, followed by a clinical assessment and echocardiographic examination. Ultrasound of the extracranial carotid arteries included measurement of IMT of the common carotid arteries, the identification of atherosclerotic plaques and the presence of stenoses. The plaques were considered if the IMT was more than 1.3 mm. RESULTS: Patients with IMT > 0.8 are older (61.5 +/- 8.2 vs. 56.1 +/- 8.2 years, p = 0.001); the prevalence of arterial hypertension is greater (63.8% vs. 21.6%, p = 0.05), and at an IMT of more than 1.1 mm all were hypertensive; the association with peripheral arterial disease is significant at the IMT = 0.8 mm (23.6% vs. 4.8%, p = 0.01). The relationship with echocardiographic markers of left ventricular hypertrophy is present at an IMT of 0.8 mm and is evident at IMT = 1 mm (interventricular septum 13.2 +/- 3 vs. 12 +/- 2.3, p = 0.05; left ventricular wall 14 +/- 5.4 vs. 12 +/- 1.7, p = 0.01; left ventricular mass 323 +/- 94 vs. 282 +/- 68, p = 0.03), and also the relation with the degree of diastolic dysfunction expressed by E/A ratio (0.71 +/- 0.24 vs. 0.99 +/- 0.39, p = 0.001). The presence of atherosclerotic plaques correlates with gender (45.1% at male vs. 24.3%, p = 0.01) and older age (61.7 +/- 8.6 vs. 56.2 +/- 8.5 years, p = 0.001). IMT and carotid plaques are not significantly correlated either with such risk factors as smoking, hypercholesterolemia, diabetes mellitus or clinical conditions as myocardial infarction and angina. CONCLUSION: IMT greater than 0.8 mm is a marker of increased cardiovascular risk, associated with age, presence of peripheral arterial disease, arterial hypertension, left ventricular hypertrophy, and diastolic dysfunction. IMT seems to be a more reliable index of cardiovascular risk than carotid plaques. Measurement of IMT is easy to be done in clinical practice, and is recommended for more accurate risk stratification in patients with atherosclerotic cardiovascular disease.

[Carotid atherosclerotic alterations revealed at ultrasonographic examination in patients with coronary heart disease]. / Modificari aterosclerotice carotidiene evidentiate la examinarea ultrasonografica la pacienti coronarieni.

UNLABELLED: Carotid ultrasound examination is a noninvasive method with large indications in the evaluation of atherosclerotic lesions at cardiac patients. The aims of the study were: the ultrasound assessment of extra cranial carotid system at patients with coronary heart disease; relationship with the cardiovascular risk factors, lipid profile and echocardiographic data. METHODS: There were studied 47 patients with coronary heart disease (angina, myocardial infarction, ischemic cardiomyopathy, CABG). The evaluation included cardiovascular risk factors, clinical examination, serum lipids and glucose, echocardiographic data. The ultrasound examination of the carotid arteries included the measurement of the diameter and intima-media thickness (IMT) of the common carotid arteries, the presence and location of atherosclerotic plaques and the presence and severity of carotid stenosis. RESULTS: There was a significant increase of the diameter and IMT with age (p=0.009 respectively p=0.05). Males had a greater medium diameter than women (7.8 +/- 0.9 mm vs. 7.3 +/- 0.8 mm, p=0.04). There was no significant relationship between the cardiovascular risk factors (smoking, arterial hypertension, diabetes mellitus, dyslipidemia) and IMT. The thickness of the interventricular septum (at the echocardiographic examination) correlated with the IMT (p=0.03). All the patients with myocardial infarction revealed carotid atherosclerotic plaques and most of the smokers had carotid plaques (88.9% vs. 44.8%, p=0.03). Patients with carotid plaques were older (60.9 +/- 10.1 vs. 54.8 +/- 6.1, p=0.02). CONCLUSIONS: The incidence of carotid atherosclerosis increases with age; the carotid diameter is greater at males and older patients; IMT is influenced mainly by age; carotid plaques are present mainly at older patients, at smokers and those with myocardial infarction and can be considered an additional risk factor for vascular

Enhancement of insulin-stimulated myocardial glucose uptake in patients with Type 2 diabetes treated with rosiglitazone.

AIMS: Peroxisome proliferator-activated receptor gamma (PPARgamma) activators have recently been identified as regulators of cellular proliferation, inflammatory responses and lipid and glucose metabolism. These agents prevent coronary arteriosclerosis and improve left ventricular remodelling and function in heart failure after myocardial infarction. Improvement in myocardial metabolic state may be one of the mechanisms behind these findings. The aim of this study was to investigate the effects of rosiglitazone on myocardial glucose uptake in patients with Type 2 diabetes. Placebo and metformin were used as control treatments. METHODS: Forty-four patients were randomized to treatment with rosiglitazone (4 mg b.i.d.), metformin (1 g b.i.d.) or placebo in a 26-week double-blinded trial. Myocardial glucose uptake was measured using [(18)F]-2-fluoro-2-deoxy-D-glucose ([(18)F]FDG) and positron emission tomography (PET) during euglycaemic hyperinsulinaemia before and after the treatment. RESULTS: Rosiglitazone increased insulin-stimulated myocardial glucose uptake by 38% (from 38.7 +/- 3.4 to 53.3 +/- 3.6 micromol 100 g(-1) min(-1), P = 0.004) and whole body glucose uptake by 36% (P = 0.01), while metformin treatment had no significant effect on myocardial (40.5 +/- 3.5 vs. 36.6 +/- 5.2, NS) or whole body glucose uptake. Myocardial work as determined by the rate-pressure-product was similar between the groups. Neither treatment had any significant effect on fasting serum free fatty acids (FFA) but the FFA levels during hyperinsulinaemia were more suppressed in the rosiglitazone group (-47%, P = 0.02). Myocardial glucose uptake correlated inversely to FFA concentrations both before (r =-0.54, P = 0.002) and after (r = -0.43, P = 0.01) the treatment period in the pooled data. Furthermore, the increase in myocardial glucose uptake correlated inversely with interleukin-6 (IL-6) concentrations (r = -0.58, P = 0.03). CONCLUSIONS: In addition to the improvement in whole body insulin sensitivity, rosiglitazone treatment enhances insulin stimulated myocardial glucose uptake in patients with Type 2 diabetes, most probably due to its suppression of the serum FFAs.

[Chronic myocardial infarction. Clinical symptoms in elderly patients]. / Particularitati clinice ale pacientilor vârstnici cu infarct miocardic cronic.

UNLABELLED: Although there is an increasing prevalence of coronary heart disease at the old age, the frequency of chronic myocardial infarction seems to be less in favour of other forms of manifestation. The objective of the study was the assessment of the clinical features of patients with chronic myocardial infarction at a population of coronary patients over 65, admitted in the Department of Cardiac Rehabilitation. METHODS: There have been selected patients over 65 years with ischaemic heart disease: 29 with chronic myocardial infarction (Group A), and 31 with other forms of coronary heart disease (Group B). There were analysed cardiovascular risk factors, symptoms, lipidic profile, echocardiographic findings. RESULTS: Mean age of the groups A and B are 69.9 +/- 4.7 and respectively 71.6 +/- 4.9. Arterial hypertension is more frequent at group B (28/31 vs 22/29, p=0.05); at group A there is a higher rate of smoking (13/29 vs 8/31, p=0.007) and diabetes mellitus (12/29 vs 3/31, p=0.001). Dyspnea is prevalent at group B (26/31 vs 21/29, p=0.01), and the resting heart rate is greater at the same group (89 +/- 19/min vs 74 +/- 14/min, p=0.02). Group A associates more frequent atherosclerotic neurologic and peripheric disease (7/29 vs 5/31 p=0.05 and respectively 6/29 vs 4/31, p=0.01). Although the ejection fraction has similar values (53.9 +/- 10% at group A and 53.8 +/- 14% at group B), the regional contractility abnormalities are more frequent at group A (17/29 vs 11/31, p=0.005). CONCLUSIONS: Old patients with chronic myocardial infarction are especially male gender, associate smoking, diabetes mellitus, other atherosclerotic neurological and peripheric diseases; the regional contractility disturbances are more prevalent at this group.