The role of chemokine CCL5/RANTES and metalloproteinase-9 as inflammatory modulators in symptomatic internal carotid artery stenosis.

Up to 80% of all ischemic strokes (IS) attributed to internal carotid athero-occlusive artery stenosis (ICAS) are related to a thromboembolic mechanism. One athero-occlusive ischemic event increases the risk for ischemia in another vascular territory, resulting from inflammation within the atherosclerotic plaque induced by cytokines. Thus, ultrasonographic characteristics of vulnerable plaques in ICAS, including plaque echolucency and ulceration might correspond to cytokine activity. The present study aimed to investigate the associations between serum cytokines and atherosclerotic plaque characteristics and the 3-year risk of a major adverse coronary and carotid ischemic event (MACCE) in symptomatic patients treated for ICAS. Plaque characteristics on ultrasonography, serum levels of C-C motif chemokine ligand 5 (CCL5)/regulated on activation, normal T-cell expressed and secreted (RANTES), metalloproteinase-9 (MMP-9), interleukin-6 (IL-6), transforming growth factor beta (TGF-ß), C-X-C motif chemokine ligand 16 (CXCL16), FAS ligand (FASL) and high sensivity C-reactive protein (hs-CRP) were analyzed in 103 symptomatic patients with ICAS prior to carotid revascularization. The incidence of MACCE: cardiovascular death (CVD), myocardial infarction (MI) and recurrent ischemic stroke (IS) were recorded prospectively for up to 5 years (median 37; IQR 21 - 40 months). Echolucent plaques, in comparison to echogenic plaques, displayed lower median levels of RANTES (P = 0.042) but higher median levels of IL-6 (P = 0.039). There was no relationship between plaque characteristics and median levels of MMP-9, TGF ß, CXCL16, FASL, or hs-CRP (P = NS). During follow-up, MACCE occurred in 15 (14.6%) patients. Univariate Cox proportional hazard analysis indicated median RANTES levels < 45.5ng/mL (hazard ratio (HR) = 3.95; 95%CI = 1.10 - 14.2; P = 0.035), MMP-9 > 0.6 µg/mL (HR 4.5; 95%CI = 1.4 - 13.9; P = 0.009), renal impairment (HR 3.48; 95%CI = 1.29 - 9.34; P = 0.013) as potential MACCE risk factors. On multivariate Cox proportional hazard analysis, MMP-9 > 0.6 µg/mL and RANTES < 45.5 ng/ml were associated with a 4.72-fold (95%CI = 1.3 - 17.0; P = 0.017) and a 3.8-fold risk increase (95%CI = 1.07 - 13.89; P = 0.038) of MACCE. Kaplan-Meier analysis showed significant differences in MACCE-free survival rates depending on RANTES and MMP-9 median levels. We conclude that serum RANTES, IL-6, and MMP-9 were associated with plaque vulnerability and predicted adverse MACCE in patients treated for ICAS.

Vibrational spectroscopy of water at interfaces.

Understanding liquid water's behavior at the molecular level is essential to progress in fields as disparate as biology and atmospheric sciences. Moreover, the properties of water in bulk and water at interfaces can be very different, making the study of the hydrogen-bonding networks therein very important. With recent experimental advances in vibrational spectroscopy, such as ultrafast pulses and heterodyne detection, it is now possible to probe the structure and dynamics of bulk and interfacial water in unprecedented detail. We consider here three aqueous interfaces: the water liquid-vapor interface, the interface between water and the surfactant headgroups of reverse micelles, and the interface between water and the lipid headgroups of aligned multi-bilayers. In the first case, sum-frequency spectroscopy is used to probe the interface. In the second and third cases, the confined water pools are sufficiently small that techniques of bulk spectroscopy (such as FTIR, pump-probe, two-dimensional IR, and the like) can be used to probe the interfacial water. In this Account, we discuss our attempts to model these three systems and interpret the existing experiments. For the water liquid-vapor interface, we find that three-body interactions are essential for reproducing the experimental sum-frequency spectrum, and presumably for the structure of the interface as well. The observed spectrum is interpreted as arising from overlapping and canceling positive and negative contributions from molecules in different hydrogen-bonding environments. For the reverse micelles, our theoretical models confirm that the experimentally observed blue shift of the water OD stretch (for dilute HOD in H(2)O) arises from weaker hydrogen bonding to sulfonate oxygens. We interpret the observed slow-down in water rotational dynamics as arising from curvature-induced frustration. For the water confined between lipid bilayers, our theoretical models confirm that the experimentally observed red shift of the water OD stretch arises from stronger hydrogen bonding to phosphate oxygens. We develop a model for heterogeneous vibrational lifetime distributions, and we implement the model to calculate isotropic and anisotropic pump-probe decays. We then compare these results with experimental data. Clearly, recent experimental advances in vibrational spectroscopy have led to beautiful new results, providing information about the structure and dynamics of water at interfaces. These experimental and concomitant theoretical advances (particularly the unified theoretical framework of non-linear response functions) have greatly contributed to our understanding of this unique and important substance.

Interpretation of the water surface vibrational sum-frequency spectrum.

We propose a novel interpretation of the water liquid-vapor interface vibrational sum-frequency (VSF) spectrum in terms of hydrogen-bonding classes. Unlike an absorption spectrum, the VSF signal can be considered as a sum of signed contributions from different hydrogen-bonded species in the sample. We show that the recently observed positive feature at low frequency, in the imaginary part of the signal, is a result of cancellation between the positive contributions from four-hydrogen-bonded molecules and negative contributions from those molecules with one or two broken hydrogen bonds. Spectral densities for each of these subgroups span the entire relevant spectral range. Three-body interactions within our newly developed E3B water simulation model prove to be critical in describing the proper balance between different hydrogen-bonded species, as (two-body) SPC/E, TIP4P, and TIP4P/2005 models fail to reproduce the positive feature. The results clarify the molecular origin of the VSF signal, and highlight the importance of many-body interactions for water in heterogeneous situations.

Robust three-body water simulation model.

The most common potentials used in classical simulations of liquid water assume a pairwise additive form. Although these models have been very successful in reproducing many properties of liquid water at ambient conditions, none is able to describe accurately water throughout its complicated phase diagram. The primary reason for this is the neglect of many-body interactions. To this end, a simulation model with explicit three-body interactions was introduced recently [R. Kumar and J. L. Skinner, J. Phys. Chem. B 112, 8311 (2008)]. This model was parameterized to fit the experimental O-O radial distribution function and diffusion constant. Herein we reparameterize the model, fitting to a wider range of experimental properties (diffusion constant, rotational correlation time, density for the liquid, liquid/vapor surface tension, melting point, and the ice Ih density). The robustness of the model is then verified by comparing simulation to experiment for a number of other quantities (enthalpy of vaporization, dielectric constant, Debye relaxation time, temperature of maximum density, and the temperature-dependent second and third virial coefficients), with good agreement.

On the calculation of rotational anisotropy decay, as measured by ultrafast polarization-resolved vibrational pump-probe experiments.

Polarization-resolved vibrational pump-probe experiments are useful for measuring the dynamics of molecular reorientation. The rotational anisotropy observable is usually modeled by the second-Legendre-polynomial time-correlation function of the appropriate molecule-fixed unit vector. On the other hand, more elaborate calculations that include non-Condon effects, excited-state absorption, and spectral diffusion, can be performed using the infrastructure of the nonlinear response formalism. In this paper we present "exact" (within the impulsive limit) results from the nonlinear response formalism, and also a series of approximations that ultimately recover the traditional result mentioned above. To ascertain the importance of these effects not included in the traditional approach, we consider the specific case of dilute HOD in H(2)O. We find that for the frequency-integrated anisotropy decay, it is important to include non-Condon effects. For the frequency-resolved anisotropy decay, non-Condon effects, excited-state absorption, and spectral diffusion are all important. We compare our results with recent experiments.

Association of increased carotid intima-media thickness with the extent of coronary artery disease.

OBJECTIVE: To investigate (a) the relation between intima-media thickness (IMT) in carotid arteries and the extent of coronary artery disease (CAD); and (b) whether IMT is predictive of coronary atherosclerosis. The coexistence of severe extracranial atherosclerosis in patients with CAD was also analysed. METHODS: Coronary angiography and carotid ultrasound evaluation were performed in 558 consecutive patients (438 men), with a mean (SD) age of 58.8 (9.2) years and suspected CAD. Mean IMT was measured at both carotid arteries and expressed as the mean aggregate value. The relation between IMT and severity of CAD was determined. RESULTS: A significant correlation between mean IMT and advancing CAD (p < 0.0001) was found. Four independent predictors of CAD were found in the discriminant analysis: age (p = 0.0193), hyperlipidaemia (p < 0.0001), smoking (p = 0.0032), and IMT (p < 0.0001). A significant increase in IMT was observed among patients with one, two, and three vessel CAD. A log normal distribution of IMT values showed that if mean IMT was over 1.15 mm, patients had a 94% probability of having CAD, with sensitivity of 65% and specificity of 80% in the patients with a high risk of CAD. The number of critically stenosed extracranial arteries increased with advancing CAD. None of the patients with normal coronary arteries had severe stenosis of the extracranial arteries. Severe carotid, vertebral, or subclavian stenosis was found in 16.6% of patients with three vessel CAD. CONCLUSIONS: IMT increases with advancing CAD, patients with mean IMT over 1.15 mm have a 94% likelihood of having CAD, and the coexistence of CAD with severe stenosis of aortic arch arteries is relatively high and was found in 16.6% of patients with three vessel CAD.

Comparison of dual-chamber pacing with nonsurgical septal reduction effect in patients with hypertrophic obstructive cardiomyopathy.

OBJECTIVES: The aim of the study was to compare the influence of dual-chamber pacing vs. nonsurgical septal reduction on hemodynamic and morphological parameters in patients with obstructive form of hypertrophic cardiomyopathy. METHODS: Nineteen patients with dual-chamber pacing (group I) and 9 patients who underwent nonsurgical septal reduction (group II) were studied at baseline and after a 6-month follow-up. The changes of left ventricular outflow tract gradient and posterior wall thickness (as an index of left ventricular hypertrophy regression) were compared. RESULTS: The baseline left ventricular outflow tract gradient was comparable between group I and group II (77+/-25 vs. 82+/-25 mm Hg, p>0.05). At 6-month follow-up, the left ventricular outflow tract gradient was reduced to a similar level in both groups (28+/-19 vs. 25+/-12 mm Hg, p>0.05). At baseline, posterior wall hypertrophy was comparable between groups (12.9+/-1.7 vs. 13.6+/-2.2 mm, p>0.05). During follow-up, the posterior wall thickness was unchanged in the pacing group (12.9+/-1.7 vs. 12.6+/-1.6 mm, p>0.05), whereas nonsurgical septal reduction induced regression of left ventricular hypertrophy in myocardial region remote from the infarcted septal segment (13.6+/-2.2 vs. 10.5+/-2.3 mm, p<0.003). CONCLUSION: Despite comparable reduction of instantaneous left ventricular outflow tract gradient, the nonsurgical septal reduction decreased posterior wall thickness, whereas pacing did not reduce left ventricular hypertrophy. Thus, regression of left ventricular hypertrophy that appeared solely after nonsurgical septal reduction may reflect the more permanent reduction of left ventricular pressure overload. Thus, not only hemodynamic but also morphological benefit from nonsurgical septal reduction seems to indicate the superiority of this method over dual-chamber pacing.

Detection of Helicobacter pylori specific DNA in human atheromatous coronary arteries and its association to prior myocardial infarction and unstable angina.

BACKGROUND: Chronic infections have been proposed to play a role in the aetiology or progression of atherosclerotic plaques. Increased risk of coronary artery disease has been suggested in patients seropositive for Helicobacter pylori. AIM: To analyse coronary specimens in patients with severe (coronary artery disease) for Helicobacter pylori specific DNA. PATIENTS AND METHODS: Atherosclerotic plaques were obtained in 46 consecutive patients (9 female, 37 male, mean age 62.7+/-9.17 years) during coronary bypass procedures. Serum was analysed for IgG -/cagA-antibodies specific for Helicobacter pylori. Polymerase chain reaction and sequence analysis were used to identify bacterial DNA. Coronary artery biopsies from 19 autopsies without coronary artery disease were examined as a control group. RESULTS: Of the 46 coronary artery disease patients, 32 (69.6%) were Helicobacter pylori seropositive. Positive results for Helicobacter pylori DNA showed 18 seropositive and 4 seronegative (with anamnesis of eradication therapy). A total of 22 patients (47.8%) of the coronary artery disease group but none of controls revealed positive DNA. In the coronary artery disease group, a correlation between DNA presence and prior myocardial infarction (p=0.008) and unstable angina (p<0.001) was found. CONCLUSION: Identification of DNA in atherosclerotic plaques of patients with severe coronary artery disease supports the hypothesis that Helicobacter pylori infection may influence the development of atherosclerosis. Our results may indicate an direct involvement of Helicobacter pylori in the progression and instability of plaques in these patients.

Metabolite ratios measured with a short echo time 1H-MRS in the frontal lobe of young healthy subjects: an approach to generate reference 1H-MRS data.

Proton magnetic resonance spectroscopy (1H-MRS) performed with a semi-automated Elscint Prestige 2 Tesla tomograph/spectroscope was used to determine the ratios of the most prominent resonances recorded from the 2 x 2 x 2 cm voxels located in the frontal lobe of healthy young males and females. The values of major metabolite ratios (NAA/Cr, Cho/Cr and ml/Cr) were normally distributed and comparable to results reported by other groups using advanced automated equipment. The coefficients of variation were smaller when the composed metabolite ratios (i.e. the ratios of a given resonance signal to the sum of all signals considered) were calculated. The composed metabolite ratios approach may be more sensitive for discrimination between normal and pathologically changed brain.

Incidence of Chlamydia pneumoniae infection in patients with coronary artery disease subjected to angioplasty or bypass surgery.

BACKGROUND: Seroepidemiological, pathological and animal studies suggest that chronic infection with Chlamydia pneumoniae (Cp) may directly impact the development or progression of atherosclerosis and coronary heart disease. The aim of the present study was to determine the seroprevalence of Cp infection and markers of systemic inflammation in patients undergoing routine coronary artery examination and prior to heart revascularization. MATERIAL AND METHODS: The research involved 76 patients with severe CAD and 81 control patients with normal coronary circulation confirmed by coronary angiography. The presence of serum IgG and IgA antibodies to Cp and plasma interleukin-8 (IL-8) levels was measured by EIA test. Furthermore, the levels of plasma C-reactive protein, fibrinogen, total cholesterol, and triglycerides were measured in all patients. RESULTS: Seropositivity to Cp was found in 60.5% for IgG and in 61.8% of cases for IgA with CAD patients, as compared to 26.0% and 29.5% in the controls (p<0.001), respectively. The levels of Interleukin-8, plasma fibrinogen, total cholesterol and triglycerides were significantly higher (p<0.001) in the CAD group, while C-reactive protein tended to have a higher value in patients with atherosclerosis than in the control group, although the difference was not significant. CONCLUSIONS: Cp infection significantly increases the risk of CAD, usually requiring coronary bypass surgery or percutaneous coronary intervention as effective measures. It may also modify the levels of serum lipids, CRP and fibrinogen, increasing the risk of atherosclerosis. The strong correlation between the elevated IgG and IgA titers of Cp in patients treated with angioplasty or surgery may impact their follow-up; this issue requires further investigation.

Prevalence of Helicobacter pylori infection in coronary artery disease and effect of its eradication on coronary lumen reduction after percutaneous coronary angioplasty.

BACKGROUND: Gastric infection caused by Helicobacter pylori has recently been associated with increased risk of coronary artery disease. AIM: To: 1) determine seroprevalence of Helicobacter pylori and its cytotoxin associated gene A in patients with/without coronary artery disease (group A), 2) assess influence of Helicobacter pylori eradication on coronary artery lumen reduction after percutaneous coronary angioplasty (group B) and 3) determine influence of Helicobacter pylori eradication on plasma cytokines, lipids and coagulation factors in patients subjected to percutaneous coronary angioplasty (group B). PATIENTS AND METHODS: Group A included 100 patients with coronary artery disease (subgroup 1) and 100 patients without (subgroup II). For Helicobacter pylori seroprevalence, plasma anti-Helicobacter pylori and anti-cytotoxin associated gene A IgG were examined. Group B included 40 patients with significant single-vessel coronary arterial disease and Helicobacter pylori infection confirmed by 13C-urea breath test and serologically using anti-Helicobacter pylori and anti-cytotoxin associated gene A IgG. Six months after percutaneous coronary angioplasty and triple anti-Helicobacter pylori therapy, the Helicobacter pylori status reassessed by urea breath test was negative in all but two patients of subgroup I subjected to Helicobacter pylori therapy. Coronary angiography and laboratory tests were repeated in both subgroups of group B included in the trial and reduction in coronary artery lumen in these subgroups was compared to baseline after percutaneous coronary angioplasty considered as 100%. RESULTS: Helicobacter pylori seropositivity reached 81.5% of coronary artery disease (subgroup I) and was significantly higher than that in controls without coronary artery disease (subgroup II) (51%), the odds ratio being 4.3 for Helicobacter pylori in coronary artery disease. Cytotoxin associated gene A IgG detection was also significantly higher (47.3%) in coronary artery disease than in controls (28%) giving the odds ratio about 2.3. Mean coronary artery lumen reduction in patients undergoing percutaneous coronary angioplasty + Helicobacter pylori eradication therapy (subgroup I) was significantly (p<0.05) smaller compared to percutaneous coronary angioplasty + placebo-treated subgroup II (22% vs 41%). CONCLUSIONS: 1) There is a significant link between coronary artery disease and infection with Helicobacter pylori, especially expressing CagA proteins, 2) Helicobacter pylori eradication significantly attenuates reduction in coronary artery lumen in coronary artery disease patients after percutaneous coronary angioplasty possibly by elimination of chronic inflammation and decline in proinflammatory cytokine release, and 3) Infection of Chlamydia pneumoniae in these percutaneous coronary angioplasty patients is not affected by eradication therapy.

Long-term outcome in patients with unstable angina treated by coronary balloon angioplasty.

UNLABELLED: Comparison of balloon angioplasty results in 472 patients with stable angina (SA) and 158 patients with unstable angina (UA) in 5-year follow-up is reported. Clinical success rate did not differ significantly, while periprocedural complications rate was higher in UA group (22.3 vs. 11.1%, P<0.001). During follow-up UA patients demonstrated higher: restenosis rate (48.5 vs. 30.4%, P<0.001), incidence of myocardial infarction (8.8 vs. 3.0%, P=0.004), although cardiac mortality did not differ significantly (2.2 vs. 1.6%). Reintervention rate in patients with unstable angina resultant from restenosis or significant artherosclerosis progression in coronary vessels, or originating from both of them, was also higher (53.7 vs. 34.1%, P<0.001). Event-free survival was significantly lower in UA patients (43.4 vs. 61.3%, P=0.02). The uni- and multivariate analysis proved that unstable angina was an independent risk factor in restenosis, re-intervention and cardiac events rate, despite perceptible differences in the baseline characteristics. Sub-group analysis of UA patients according to Braunwald classification revealed lower success rate and higher incidence of myocardial infarction during follow-up in post-infarction angina (class C), whereas new onset, no-rest angina (class I) had higher event-free survival in comparison with rest angina (classes II and III). CONCLUSIONS: UA patients treated by balloon angioplasty had higher periprocedural complications rate, as well as restenosis and re-intervention rate. Despite higher cardiovascular events rate during 5-year follow-up in UA group, survival rate in both groups was high and cardiac mortality did not differ significantly. Unstable angina constitutes a strong independent risk factor in adverse long-term outcome.

[Clinical outcome in patients after single vessel PTCA with multiple stent implantation]. / Ocena chorych leczonych angioplastyka wiencowa i implantacja dwóch i wiecej stentów do jednej tetnicy.

Multiple stenting in a coronary artery may improve the angiographic result of unsatisfactory percutaneous coronary angioplasty (PTCA) but little is known about its clinical outcome. We evaluated 42 patients who underwent multiple contiguous stent implantation (2-4 stents) within a single coronary artery in order to achieve optimal vessel reconstruction. Procedural success rate was 95%. In-hospital events included myocardial infarction in 2 patients (5%) and acute stent thrombosis in 2 patients (5%). Acute stent thrombosis was successfully treated with repeated PTCA and abciximab infusion. The mean stented segment length was 33.5 +/- 9.9 mm. In 23 patients (54.8%) stents were implanted due to abrupt or threatened artery closure (bailout), in 9 (21.4%) following total chronic artery occlusion and in 10 (23.8%) due to a suboptimal result of angioplasty (i.e. provisional stenting). The bailout stent implantation was most frequent in the left anterior descending artery (15 out of 23 patients, i.e. 65.2%). Long-segment multiple stenting was performed mainly in the right coronary artery to maintain recanalization after the chronic artery occlusion (6 out of 9 patients, i.e. 66.7%). Mean data for all studied patients revealed a significant improvement in the exercise stress test parameters after the procedure (exercise time: 8.5 +/- 3.9 vs. 11.4 +/- 3.5 min, maximal load: 5.4 + 3.0 vs. 7.6 +/- 2.9 METS, percent of the maximal predicted effort 75.5 +/- 10.3 vs. 83.2 +/- 9.2%, p < 0.01 for all). Although the sub-group analysis showed a significant increase in exercise test parameters in patients treated with stent implantation due to the bailout (p < 0.05), the increase did not reach statistical significance in the group of patients who underwent multiple stent implantation to maintain recanalization after chronic artery occlusion or to improve the result of angioplasty. At 14.9 +/- 8.3 months follow-up restenosis was found in 14 (33%) patients. It was successfully treated either with re-PTCA (10 patients, i.e. 23%) or with bypass surgery (4 patients, i.e. 10%). Interestingly, the length of the stented segment was not significantly higher in those patients who developed restenosis. No patient died sustained myocardial infarction or subacute stent thrombosis. We conclude that multiple stent implantation is a safe procedure, with an insignificant complication rate. Best outcome is seen when multiple stent implantation is performed for the left anterior descending artery bailout. Reconstruction of the right coronary artery due to chronic total occlusion usually requires multiple stent implantation. When multiple contiguous stent implantation is performed due to the suboptimal PTCA result, it does not seem to improve the clinical outcome as evaluated by exercise stress test. Although the risk of restenosis is increased, subacute stent thrombosis seems rare with multiple one-vessel stenting.

[Long term outcome in patients with and without restenosis after coronary angioplasty]. / Odlegle obserwacje u chorych z restenoza i bez nawrotu zwezenia po angioplastyce wiencowej.

Restenosis at dilatation site still constitutes a significant limitation of percutaneous coronary revascularisation. Majority of patients with restenosis are treated with repeat angioplasty, although its impact on long-term outcome is still little known > Very few studies focused on this issue bring rather discrepant results. The present study is aimed at assessing the impact of restenosis on long-term outcome in patients treated with coronary angioplasty. A group of 567 patients, who in the years 1987-1996 had successfully undergone percutaneous balloon coronary angio-plasty (PTCA) at our Clinic, was retrospectively divided into two groups: a group comprising 188 patients (33.2%) suffering from recurrent angina in whom restenosis had been established through control angiography, and a group comprising 379 patients (66.8%) who during the observation period exhibited no angina symptoms, or in whom the control angiography did not reveal restenosis. The restenotic patients were older (p = 0.007), more frequently exhibited symptoms of unstable angina upon PTCA (p < 0.0001), and there were also fewer smokers among them (p = 0.02). Furthermore, restenotic patients more frequently had multivessel and multilesion angioplasty (p = 0.025; p = 0.004, respectively). Restenosis after the first PTCA was treated by repeated angioplasty in 149 (79.3%) patients, 26 (13.8%) underwent CABG operation and 13 (6.9%) patients were treated pharmacologically without repeated revascularization. Within the 5-year observation period the mortality rate in both groups did not differ significantly (5.9% vs. 4.0%). Restenotic patients sustained myocardial infarctions more frequently (8.0% vs. 3.2%, p = 0.01), had significant atherosclerosis progression (37.2% vs. 15.0%, p < 0.0001), and were more frequently subjected to repeated interventions (37.2% vs. 15.0%, p < 0.0001), both PTCA (79.3% vs. 11.6% p < 0.0001) and CABG surgery (32.5% vs. 4.2%, p < 0.0001), as well as to multiple re-interventions (31.9% vs. 4.8%, p < 0.0001), in comparison with the non-restenotic ones. Analysis of functional status of patients assessed in compliance with the CCS criteria at the end of the observation period proved that significantly more non-restenotic patients did not experience angina, or experienced it rather sporadically (CCS Class 0 and 1). Logistic regression uni- and multivariate analysis proved that restenosis is an independent risk factor of myocardial infarction, reinterventions--also multiple ones--and cardiac events, although not mortality.

Long-term outcome of coronary balloon angioplasty in diabetic patients.

Diabetes is recognised to increase morbidity and mortality after coronary revascularization. We compared clinical outcomes in mean 5-year-long follow-up of coronary balloon angioplasty in diabetic and non-diabetic patients. We studied 621 patients undergoing elective angioplasty from 1987 to 1996. There were 60 (9.7%) patients with diabetes who were compared with 561 non-diabetic patients. Diabetics were older, more often obese, less frequently were current smokers, and less frequently had hypercholesterolaemia. Diabetic patients in comparison with non-diabetics had lower ejection fraction and more frequently had angioplasty of complex (B2 or C) lesions, but there were no differences between both groups in the other clinical and angiographic risk factors. Clinical success of angioplasty, as well as complications rate were similar in both groups. In follow-up restenosis occurred more frequently in diabetics (46.3 vs. 32.2%, P=0.03), resulting in significantly higher re-intervention rate (50.0 vs. 35.4%, P=0.03). Especially diabetic patients were more frequently referred to CABG (20.4 vs. 9. 9%, P=0.02). There were no significant differences in deaths (1.9 vs. 2.8%) and myocardial infarction (3.7 vs. 4.4%). Diabetics presented worse CCS status at the end of observation (Class 0 and I - 61.1 vs. 74.4%, P=0.037). Angioplasty proved to be a safe procedure in diabetic patients. Despite higher restenosis and re-intervention rate in diabetics, mortality as well as myocardial infarction rate was the same in both groups during mean 5-year follow-up.

[Long-term results of coronary balloon angioplasty in various age groups]. / Wyniki angioplastyki wiencowej u chorych w róznych grupach wiekowych.

UNLABELLED: Some data indicate that natural history of coronary artery disease in younger patients is characterised by high dynamics and therefore the long-term results of revascularisation procedures have generally poorer outcome. To verify this we compared the early and the long-term results of balloon angioplasty in 630 consecutive patients divided into four age groups: < 40 years (77 patients), 41-50 years (247 patients), 51-60 years (160 patients) and > 60 years (146 patients). Groups differed significantly in many clinical factors: higher proportion of women and unstable angina were encountered in older groups, while higher frequency of hypertension, hypertriglycerydaemia, current smoking, familial history of angina, prior myocardial infarction, were more often observed in younger patients. Groups did not differ in such angiographic factors as: global ejection fraction (EF), presence of multivessel disease, type of dilated lesions and vessels, multilesion PTCA, except higher frequency of EF < 50% in patients < 40 years of age. Immediate results of angioplasty did not differ significantly between the respective age groups: success rate was 87-94%, complications rate between 4.5% and 6.5%, complete revascularisation was achieved in 46-61% patients (NS). In the mean 5-year follow-up period repeated angiography was carried out with comparable frequency in about half of the studied patients (NS). Restenosis rate equalled 21-42% and significantly increased with the patients' age (p = 0.02 in chi 2, 0.009 in log-rank test), the related reinterventions rate likewise (p = 0.05 in chi 2, 0.009 in log-rank test). We did not observe any differences among the respective groups with regard to significant atherosclerosis progression, which was encountered in 15-19% of patients (NS). Survival rate did not differ significantly either, being in fact quite high (96-99%). Myocardial infarction in follow-up significantly more frequently (p = 0.01) occurred in patients < 40 years of age, in comparison with patients > 60 years of age, although it did not differ significantly in terms of overall test for independence (p = 0.3) and log-rank test (p = 0.07). The frequency of major coronary events significantly increased according to patients' age as opposed to the event-free survival (p = 0.02 in both tests). Uni and multivariate analysis confirmed that age over 50 years is an independent factor of restenosis, reintervention, and major coronary event in follow-up. Patients functional status at the end of observation period, according to CCS criteria, proved that in the older age groups the percentage of patients with none, or minor anginal complaints decreased, whereas the proportion of patients exhibiting the symptoms of severe angina (Class III and IV) significantly increased (p = 0.006). CONCLUSIONS: Balloon angioplasty offered similar short-term outcome in all age groups, as well as the survival rate during the 5-year follow-up period. Frequency of restenosis significantly increased in older patients especially the ones over 50 years of age; this in turn resulting in a higher reinterventions rate among them. On the other hand, patients below 40 years of age suffered more frequently from myocardial infarction during the follow-up period. Major coronary events were more frequent in patients over 50 years of age. Better functional status was observed in younger patients at the end of observation period.

[Vascular rings as a cause of the respiratory disturbances in children]. / Pierscienie naczyniowe jako przyczyna zaburzen oddychania u dzieci.

Vascular rings are an infrequent cause of tracheal and/or oesophageal compression in infants and children. The authors present 11 cases of vascular rings in children from 3 months to 15 years of age. There were: double aortic arch in 5 cases, right aortic arch with left arterial ligament in 1 case, aberrant right subclavian artery in 2 subjects and pulmonary artery sling in 3 patients. The diagnosis was established on the basis of chest X-ray examination, echocardiographic examination, bronchoscopy, angiography and magnetic resonance imaging. Surgical correction was performed in all patients with good primary results. One infant died after several months after operation because of respiratoty system complications. As many as ten subjects were sent to paediatric cardiology unit from pulmonary departments where for the first time a suspicion of vascular ring existance was undertaken. All of them were previously diagnosed and treated in paediatric hospitals, usually as bronchial asthma. It is stressed that in every case of unexplained chronic coughing it is necessary to perform at least lateral X-ray examination of the chest with contrast in oesophagus.

[The usefulness of the method of planar diffusion echo imaging (EPI DWI) in the diagnosis of cerebral ischemia]. / Przydatnosc metody echa planarnego obrazowania dyfuzyjnego (EPI DWI) w diagnostyce udarów niedokrwiennych mózgowia.

The preliminary results of MR echoplanar diffusion-weighted imaging (EPI DWI) in patients with stroke are presented. Twelve patients (5 females, 7 males) aged 36-78 years (mean 63.8) were examined by 2T system. No focal lesions were found in the acute phase of stroke on T1-weighted images. Narrowing of sulci in the region of stroke was the only abnormal finding. Focal hyperintense lesions were shown on PD and T2-weighted images in 50% of patients in the acute phase, 7 hours after the onset of clinical symptoms. On EPI diffusion-weighted images focal decrease of apparent diffusion coefficient (ADC) was observed in all cases of the acute phase of stroke after 3 hours. EPI DWI allows for earliest detection of ischaemic lesions in brain tissue. The method is especially useful in characterisation of the acute phase of stroke and shows its evolution thanks to the use of ADC.

A randomized comparison of elective high-pressure stenting with balloon angioplasty: six-month angiographic and two-year clinical follow-up. On behalf of AS (Angioplasty or Stent) trial investigators.

BACKGROUND: Previous randomized trials have shown beneficial effects of coronary stenting on restenosis and event-free survival rates. However, it has not yet been fully established if routine high-pressure stenting with an antiplatelet regimen can show similar results. METHODS: We compared the 6-month angiographic restenosis rate and 2-year event-free survival rate in 400 patients randomly assigned to stent or angioplasty. Aspirin and ticlopidine were prescribed in both groups. RESULTS: The procedural success rate did not significantly differ between the stent and angioplasty groups (97.92% vs 97.45%, P = not significant). No stent thrombosis was found. The 6-month restenosis rate was lower in the stent group (18. 18% vs 24.87%, P =.055). At 2 years target lesion revascularization rate was 17.19% in the stent group and 25.51% in the angioplasty group (P =.02, 33% reduction). No significant differences with regard to death and myocardial infarction were observed. Event-free survival rate at 6, 12, and 24 months was 86.77% vs 78.84%, 84.13% vs 76.70%, and 83.07% vs 73.54% for stent and angioplasty groups, respectively (P =.0172). CONCLUSIONS: The 6-month angiographic and 2-year clinical outcomes were better in patients who received stent than in those after balloon angioplasty. The difference in 2-year event-free survival rate was explained by a reduction in target lesion revascularization rate in the stent group.