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The insertion/deletion (I/D) polymorphism in the ACE gene and the A1166C polymorphism in the AT1R gene have been associated with left ventricular remodelling and prognosis after acute myocardial infarction ( AMI). We investigated whether these genetic variants associate with impaired left ventricular ejection fraction ( LVEF) and increased risk for in-hospital mortality after AMI. Consecutive AMI patients were recruited on admission and were genotyped for the above-mentioned polymorphisms. The frequency of the studied genotypes did not differ significantly between deceased patients and those who survived. The LVEF did not differ among patients with or without the DD genotype (45 +/- 10 vs. 45 +/- 10%, p=0.892) or the CC genotype (45 +/- 10 vs. 46 +/- 10%, p=0.859). These data question the role of the studied genotypes in the pathogenesis of AMI and do not support the previously supported hypothesis that these genotypes influence prognosis after AMI.

Background The insertion/deletion polymorphism of the angiotensin-converting enzyme (ACE) and the A1166C polymorphism of the angiotensin-II AT1 receptor (AT1R) have been extensively investigated as possible risk factors for myocardial infarction (MI). Design and methods Genetic association, case-control study, specifically designed to investigate the association of the above-mentioned polymorphisms with risk of MI in a homogeneous, low coronary risk, Caucasian population. The study population consisted of 1603 consecutive patients with acute MI who were recruited from nine clinics, located in three cities, and 699 unrelated adults who were randomly selected from the city catalogues. Results In univariate analysis, the DD genotype was found to be more prevalent among controls (40.8 vs. 35.2%, P=0.011). In multivariate analysis adjusted for age, gender, smoking status, diabetes mellitus, hypercholesterolaemia, hypertension and family history of coronary artery disease, the presence of the DD genotype was independently and negatively associated with risk of AMI (RR = 0.743,95% CI = 0.595-0.927, P= 0.008). The CC genotype was not found to be significantly associated with risk of M I, either in univariate (6.2 vs. 6.4%, P=0.856), or in multivariate analysis adjusted for the same confounders (RR = 0.743, 95% Cl = 0.473-1.167, P= 0.197). Conclusions Contrary to previous reports, in this study the DD genotype of the ACE gene, but not the CC genotype of the AT1R gene, was associated with a lower risk of MI. Our results emphasize the complexity of genotype-phenotype interactions in the pathogenesis of ischaemic heart disease and question the previously hypothesized role of the DD genotype on risk of acute myocardial infarction. (C) 2004 The European Society of Cardiology.

Objectives. Our aim was to present the immediate and inter mediate long-term results of the application of retrograde non transseptal balloon mitral valvuloplasty (RNBMV) in four cooperating centers from Greece and India, Background. RNBMV is a purely transarterial method of balloon valvuloplasty, developed with the aim to avoid complications associated with transseptal catheterization. Only single-center experience with RNBMV has been previously reported. Methods. The procedure was attempted in 441 patients with symptomatic mitral stenosis (320 women, 121 men, mean age [+/- SD] 44 +/- 11 years, mean echocardiographic score [+/- SD] 7.7 +/- 2.0) from 1988 to 1996. Three hundred eighty-five patients with successful immediate outcome were followed clinically for a mean [+/- SD] of 3.5 +/- 1.9 (range, 0.5-9.1) years. Results. A technically successful procedure was achieved in 388 (88%) cases. The echocardiographic score (p < 0.001), male gender (p = 0.005), preprocedural mitral regurgitation (p 0.007) and previous surgical commissurotomy (p = 0.029) were unfavorable predictors of immediate outcome. Complications included death (0.2%), severe mitral regurgitation (3.4%) and injury of the femoral artery (1.1%), Event free (freedom from cardiac death, mitral valve surgery, repeat valvuloplasty and NYHA class > II symptoms) survival rates (+/- SEM) were 100%, 96.9 +/- 0.9%, 89.8 +/- 1.9% and 75.5 +/- 5.5% at 1, 2, 4 and 9 years, respectively. The echocardiographic score (p < 0.001), NYHA class (p = 0.008) and postprocedural mitral valve area (p = 0.009) mere significant independent predictors of intermediate long-term outcome. Conclusions. Multicenter experience indicates that RNBMV is a safe and effective technique for the treatment of symptomatic mitral stenosis. As with the transseptal approach, patients with favorable mitral valve anatomy derive the greatest immediate and intermediate long-term benefit from this procedure. (C) 1998 by the American College of Cardiology.

The purpose of this study was to evaluate changes in the left atrial size in acute mitral regurgitation (AMR) and monitor its correction by a catheter-mounted balloon (B). In 16 dogs, pressure changes in the left atrium (LA) were related to LA size and regurgitant mitral flow after the production of AMR by severing the mitral cusps. TEE was used for evaluating LA area (ALA) and the mitral regurgitation flow area (AMRF). TEE was also used in monitoring the position of a catheter-mounted B inserted through the LV apex and positioned on the mitral ring to relieve AMR. The B was inflated during systole and deflated during diastole. The ALA increased by 4.89 +/- 1.21 cm(2) (mean +/- 1 SD) (p < 0.001) after AMR, the AMRF increased by 3.01 +/- 0.85 cm(2) (p < 0.001) and the mean atrial pressure (LAP) by 9.38 +/- 2.43 mmHg (p < 0.001). In all experiments the position of the B could be confirmed in the 2D image and in 4 the reduction of AMRF by the function of the B was documented by the colour flow Doppler. It is concluded that after AMR the size of the LA increases along with the increase in LA pressure and a phasically inflated balloon and its effect on AMR can be easily identified and monitored by TEE.

Study objective - The aim was to evaluate the effect of acute changes in aortic pressure on the coronary reserve and hyperaemic response. Design - Aortic pressure changes were induced either by intra-aortic balloon pumping or by the production of acute aortic regurgitation. A transient 20 s occlusion of the left anterior descending coronary artery was used as the hyperaemic stimulus Experimental subjects - The experiments were performed on 19 open chest anaesthetised dogs, weight 13-32 kg. Measurements and main results - During intra-aortic balloon pumping the mean diastolic aortic pressure increased by 24.7(SEM 2.9) mm Hg (p < 0.001), while in aortic regurgitation it decreased by 47.7(11.1) mm Hg (p < 0.01). At the peak hyperaemic response the driving coronary pressure was 121.4(2.8) mm Hg during intra-aortic balloon pumping and 59.8(11.5) mm Hg during aortic regurgitation. The peak hyperaemic flow increased by 12.0(3.8) ml.min-1 (p < 0.01) during intra-aortic balloon pumping, compared to the values before pumping and decreased by 14.9(4.2) ml.min-1 (p < 0.01) during aortic regurgitation, compared to the values before aortic regurgitation. The coronary reserve, expressed as the ratio of the hyperaemic to the resting flow, increased by 0.7(0.1) (p < 0.001) during intra-aortic balloon pumping and decreased by 0.4(0.2) (p < 0.05) during aortic regurgitation. A positive significant correlation coefficient was found at the peak hyperaemic response between the mean aortic pressure and the total forward effective coronary flow, and between the mean diastolic aortic pressure and the diastolic component of the coronary flow, during both intra-aortic balloon pumping and aortic regurgitation. Conclusions - The results suggest that coronary reserve increases during intra-aortic balloon pumping and decreases during aortic regurgitation; these changes could be attributed to the effect of the pressure changes on the hyperaemic flow.