Search

Circulating bone marrow (BM)-derived stem and progenitor cells (SPCs) participate in turnover of vascular endothelium and myocardial repair after acute coronary syndromes. Acute myocardial infarction (MI) produces a generalized inflammatory reaction, including mobilization of SPCs, increased local production of chemoattractants in the ischemic myocardium, as well as neural and humoral signals activating the SPC egress from the BM. Several types of circulating BM cells were identified in the peripheral blood, including hematopoietic stem cells, endothelial progenitor cells, mesenchymal stromal cells, circulating angiogenic cells and pluripotent very small embryonic-like cells; however, the contribution of circulating cells to the myocardial and endothelial repair is still unknown. The number and function of these cells is impaired in patients with diabetes and other cardiovascular risk factors, but can be improved by physical exercise and use of statins. The mobilization of SPCs in acute coronary syndromes and stable coronary artery disease seems to predict the clinical outcomes in selected groups of patients. Interpretation of the findings has to incorporate other factors that modulate the process of mobilization, such as coexisting diseases, age and medications. This review discusses the mobilization of SPCs in acute ischemia (MI, stroke), as well as in stable cardiovascular disease, and highlights the possibility of using the SPC as a marker of cardiovascular risk.

OBJECTIVE To compare extra-lipid effects of statins and fibrates in relation to the baseline metabolic status of patients. RESEARCH DESIGN AND METHODS The study involved a group of 242 metabolic syndrome patients with or without pre-diabetes and randomized to atorvastatin, fenofibrate, or placebo. RESULTS Compared with matched healthy subjects, metabolic syndrome patients exhibited higher plasma levels/activities of high-sensitivity C-reactive protein (hs-CRP), fibrinogen, factor VII, plasminogen activator inhibitor 1, and enhanced monocyte cytokine release. These abnormalities were alleviated by both atorvastatin and fenofibrate treatment. CRP-lowering and monocyte-suppressing actions were more pronounced for atorvastatin in subjects with impaired fasting glucose and for fenofibrate in patients with impaired glucose tolerance. CONCLUSIONS The presence of pre-diabetes potentiates metabolic syndrome–induced abnormalities in plasma markers of inflammation and hemostasis and in monocyte secretory function. Both atorvastatin and fenofibrate exhibit multidirectional pleiotropic effects in subjects with metabolic syndrome, the strength of which seem to be partially determined by the type of pre-diabetes.

Background: Commonly used cardiopulmonary bypass systems with cardiotomy reservoir, oxygenator, and roller pump require preoperative crystalloid filling. Radical reduction of the filling fluid volume and replacing it with the patient’s own blood has a fundamental impact on the outcome. Aim: A comparison of cardiopulmonary bypass filled with the patient’s blood, applied in Poland for the first time, and the classical system filled with crystalloids. Methods: Non-randomised trial in which patients undergoing coronary artery bypass grafting were divided into two groups: first operated on with use of cardiopulmonary bypass system with the patient’s own blood priming, and a control group operated on with standard technique. Levels of haemoglobin (HGB), haematocrit (HCT), platelets, leukocytes, creatinine, protein, C-reactive protein, procalcitonin, volume of transfused blood products, postoperative drain output, time to extubation, and consumption of catecholamines were compared. Results: The results of a study comparing the classical system with the blood-filled system (n = 60) showed a significantly smaller decrease in HGB and HCT levels (p = 0.001), resulting in reduction of blood product transfusions by 75% (p = 0.03). The new type of extracorporeal circulation reduced the total postoperative drain output by approximately 28% (p = 0.003). The systemic inflammatory response syndrome (SIRS) was less pronounced and the tissue perfusion was better due to smaller degree of haemodilution leading to better organ and heart protection. The patients required shorter mechanical ventilation times in the perioperative period. Conclusions: The use of a new system of cardiopulmonary bypass filled with the patient’s blood reduces the postoperative decrease in HGB and HCT, the amount of transfused blood products, and total postoperative drain output. It also shortens the time spent on mechanical ventilatory support.

BACKGROUND To assess the usefulness of off-pump technique for more technically demanding coronary artery bypass procedures using exclusively arterial conduits. METHODS Analysis of perioperative data of 324 consecutive patients in whom total arterial revascularization for multiple- vessel coronary artery disease was performed--181 cases on-pump and 143 cases off-pump. RESULTS On average in the on-pump group 2.7 +/- 0.8 (range, 2-5) grafts per patient were constructed versus 2.4 +/- 0.7 (range, 2-4) grafts per patient in the off-pump group (P < .001). Of the total number of 490 anastomoses performed on-pump, 83 (17%) were side-to-side and of 349 anastomoses performed off-pump, 51(15%) were side-to-side, a nonsignificant difference (P = .4). The aorta was used as a site for proximal anastomosis of 1 or more arterial conduits in 105 patients (58%) who underwent on-pump surgery and in 57 patients (40%) who underwent off-pump surgery (P = .002). In the off-pump group, the right internal thoracic artery (RITA) was rarely (12%) routed through the transverse sinus to circumflex branches compared with the on-pump group (34%) (P = .017). RITA in off-pump patients was more often used to revascularize the anterior wall (47% versus 29%; P = .08). We observed no difference in mortality (1.7% versus 0%; P = .3), incidence of perioperative myocardial infarction (8.8% versus 7.7%; P = .8), stroke (1.7% versus 1.4%; P = .8), or atrial fibrillation (24% versus 19%; P = .3). We observed less inotropic support and less blood-product use in off-pump patients. CONCLUSION Total arterial revascularization for multiple-vessel coronary artery disease may be safely performed off-pump. We observed tendency to somewhat smoother postoperative course in the off-pump group.

Background . The skeletonization of internal thoracic artery is postulated to improve graft length, early blood flow, sternal blood supply, and postoperative respiratory function. Concern exists that skeletonization may injure internal thoracic artery, precluding good results of surgery. Reports on endothelial function of skeletonized internal thoracic artery are lacking. Methods . A prospective assessment of early clinical outcomes of 357 consecutive patients undergoing coronary artery bypass grafting was performed: 287 patients with nonskeletonized and 70 with skeletonized left internal thoracic artery (LITA). The lengths of LITA and of its discarded distal segment, as well as free LITA blood flow, were measured. The dose-effect relationship for relaxation to acetylcholine was studied in the organ bath. Results . Apart from a higher incidence of breaching the pleura with nonskeletonized LITA the clinical outcomes were comparable. The length of skeletonized LITA was 17.8 ± 1.14 cm versus 20.3 ± 0.52 cm skeletonized ( p = 0.11). The length of discarded LITA was shorter in nonskeletonized artery (0.8 ± 0.28 cm versus 2.6 ± 0.49 cm; p = 0.022). The free LITA blood flow was 66.3 ± 7.42 mL/min in nonskeletonized vessel versus 100.3 ± 14.84 mL/min in skeletonized ( p = 0.048). The acetylcholine-induced relaxation was similar in both groups (maximal relaxation, 80.7% ± 5.95% in nonskeletonized versus 72.9% ± 9.11% in skeletonized; not significant; negative logarithm of half-maximal effect, 7.43 ± 0.18 versus 7.1 ± 0.10, respectively; p = 0.063). Conclusions . Skeletonization does not damage the endothelial function of the LITA. Higher free blood flow and available LITA length should encourage the use of skeletonized LITA in clinical practice.

Objective: Myocardial areas distal to complete coronary artery occlusion are poorly protected by antegrade cardioplegia. Hence, retrograde cardioplegia becomes an important adjunct in myocardial protection. An aim of the study was to compare both methods prospectively. Methods: 158 coronary artery bypass grafting (CABG) patients were randomly assigned to two groups according to myocardial protection technique: 89 patients to group 1-retrograde cold blood cardioplegia (RCBC); and 69 patients to group 2-antegrade cold blood cardioplegia (ACBC). Preoperative parameters were similar but cross-clamp time and volume of cardioplegia needed were higher in the retrograde group. The results were assessed on the basis of: (I) clinical outcome; (2) ECG and enzymatic parameters of ischemia; (3) assessment of early systolic function by means of cardiac output (CO), stroke work index (SWI), left ventricular stroke work index (LVSWI) and right ventricular stroke work index (RVSWI) taken before, and 1 and 5 h after coming off bypass; (4) late systolic and diastolic function by echo assessment of segmental contractility of 17 segments and indexes of peak transmitral flow (TMI) taken 7 days and 6 months after operation. Results: Ischemic events, inotropes and ventricular fibrillation on reperfusion were significantly more frequent in the antegrade group. Sinus rhythm at an early stage postoperatively was found more frequently in the retrograde group. All these parameters became comparable 24 h after operation. Early myocardial recovery was better in the retrograde group where intraoperative improvement in CO and SWI was significant. At the same time, SWI decreased significantly in the antegrade group. RVSWI changes were similar in both groups. There were no differences in mortality and perioperative MI. Late myocardial performance by segmental contractility and diastolic transmitral flow were similar in both groups. Conclusions: Retrograde continuous blood cardioplegia reduces ischemic injury and permits better early recovery of myocardial function. There is no difference, however, regarding long-term assessment of myocardial recovery.

Wstep: Zwezenie tetnic szyjnych (CAS) czesto wspolistnieje ze zmianami miazdzycowymi tetnic wiencowych. Objawowe CAS zwieksza ryzyko powiklan neurologicznych u chorych poddawanym pomostowaniu aortalno-wiencowemu (CABG). W przypadku bezobjawowegoCAS zarowno ryzyko, jak i sposob postepowania z chorym przed planowanym CABG nie zostaly jednoznacznie określone. Cel: Celem pracy byla prospektywna ocena wplywu istotnego jednostronnego bezobjawowego zwezenia tetnicy szyjnej wewnetrznej na wystepowanie pojedynczego punktu koncowego (obejmującego udar mozgu, zawal serca [MI] i zgon) oraz zlozonego punktu koncowego (obejmującego udar mozgu, MI i zgon) w obserwacji miesiecznej i rocznej po CABG. Metody: Analizie poddano 155 kolejnych pacjentow zakwalifikowanych w okresie od lutego do lipca 2008 r. w trybie planowym do selektywnej operacji CABG z powodu stabilnej wielonaczyniowej choroby wiencowej. Z badania wykluczono chorych z istotnymi wadami zastawkowymi oraz istotnymi objawowymi CAS, a takze tych, u ktorych wcześniej przeprowadzono zabieg rewaskularyzacji tetnic szyjnych. U wszystkich pacjentow wykonano przed CABG ultrasonografie doplerowską tetnic szyjnych. Badaną populacje podzielono na dwie grupy. Kryterium podzialu stanowilo zwezenie tetnicy szyjnej wewnetrznej ≥ 60%. Grupa I obejmowala pacjentow z jednostronnym bezobjawowym ≥ 60% zwezeniem tetnicy szyjnej wewnetrznej, a grupa II — chorych z bezobjawowym zwezeniem tetnicy szyjnej wewnetrznej < 60%. Żadna z badanych osob nie byla poddana zabiegowi rewaskularyzacji tetnic szyjnych w rocznym okresie pooperacyjnym. Wyniki: Grupa I liczyla 35 osob z jednostronnym bezobjawowym istotnym (60–99%) zwezeniem w obrebie tetnicy szyjnej wewnetrznej, a grupa II — 88 osoby ze zmianami miazdzycowymi w tetnicy szyjnej wewnetrznej < 60%. Miedzy grupami nie zaobserwowano roznic pod wzgledem: wieku (65,31 ± 8,44 vs. 64,33 ± 9,55 roku; p = 0,5955), czestości wystepowania nadciśnienia tetniczego (p = 0,2343), cukrzycy (p = 0,5495) i palenia tytoniu (p = 0,7891). Badane grupy nie roznily sie stezeniem cholesterolu calkowitego (168,91 ± 37,21 vs. 177,89 ± 37,56 mg/dl; p = 0,2343), cholesterolu frakcji HDL (44,97 ± 13,41 vs. 44,89 ± 12,83 mg/dl; p = 0,9768), triglicerydow (133,11 ± 51,75 vs. 149,95 ± 125,55 mg/dl; p = 0,4454), cholesterolu frakcji LDL (99,46 ± 29,30 vs. 103,23 ± 31,19 mg/dl; p = 0,5423) i kreatyniny (1,06 ± 0,28 vs. 1,03 ± 0,23 mg/dl; p = 0,47). Ponadto funkcja skurczowa lewej komory (LVEF) byla porownywalna w obu grupach (50,65 ± 10,23% vs. 48,87 ± 9,81%;p = 0,3789). W obserwacji miesiecznej nie stwierdzono powiklan sercowo-naczyniowych po CABG. W obserwacji rocznej nie wykazano istotnych roznic miedzy badanymi grupami pod wzgledem czestości wystepowania MI (p = 0,1005) i zgonu (p = 0,3959). Natomiast w grupie I wykazano trend w kierunku czestszego wystepowania udaru mozgu (p = 0,0692). Zlozony punkt koncowy obejmujący udar mozgu, MI i zgon cześciej wystepowal w grupie I w porownaniu z grupą kontrolną (p = 0,0097). W badaniu regresji liniowej wykazano związek miedzy istotnym jednostronnym bezobjawowym zwezeniem tetnicy szyjnej wewnetrznej a udarem mozgu (p = 0,0041), a takze miedzy istotnym zwezeniem tetnicy szyjnej wewnetrznej a zlozonym punktem koncowym obejmującym udar mozgu, MI i zgon (p = 0,0475). W analizie wieloczynnikowej regresji liniowej potwierdzono zaleznośc miedzy istotnym jednostronnym bezobjawowym zwezeniem tetnicy szyjnej wewnetrznej a udarem mozgu (p = 0,0467). Wnioski: 1. Istotne jednostronne bezobjawowe zwezenie tetnicy szyjnej wewnetrznej nie zwieksza czestości zdarzen sercowo-naczyniowychw obserwacji miesiecznej u chorych leczonych za pomocą CABG z powodu stabilnej choroby wiencowej. 2. Obecnośc istotnego jednostronnego bezobjawowego zwezenia tetnicy szyjnej wewnetrznej wiąze sie z czestszym wystepowaniem udaru mozgu i zlozonego punktu koncowego obejmującego udar mozgu, MI i zgon u chorych po CABG w obserwacji rocznej.

Results are presented which assess the reactivity of isolated human internal mammary artery fragments from non-hypertensive and treated hypertensive patients in vitro. Material from three patient groups was examined: group I, no hypertension; group II, arterial hypertension treated with ACE inhibitors; and group III, arterial hypertension treated with nifedipine. Responses to KCl, norepinephrine and acetylcholine, as well as the influence of N(G)-monomethyl-L-arginine (L-NMMA) on the effects of norepinephrine were tested. Response to KCl was highest in group III, while the contractile reactivity to norepinephrine was depressed in group II. Relaxation after acetylcholine was enhanced in groups II and III. Incubation of vessel fragments with L-NMMA sensitized the tissue to norepinephrine in the order of potency group II>group III>group I. Internal mammary artery function as the graft, and particularly in terms of endothelial function, is not adversely affected in arterial hypertension, although proper antihypertensive treatment may be essential.

Objective: The aim of the study was to assess gastric mucosal pH during certain parts of a major cardiac procedure (hypo- and normothermic), and then throughout the first postoperative day. Methods: Gastric mucosal pH was measured using a tonometer, in 15 patients subjected to elective CABG procedures. The patients were also assessed haemodynamically and serum lactate concentrations were measured. Results: It was found that cardiopulmonary bypass did not suppress visceral perfusion. The most critical was the period between 4th and 12th postbypass hour when a tendency towards decreased cardiac output and oxygen delivery was noted. At the same time oxygen consumption was increasing which resulted in triggering of anaerobic metabolic pathways, that was mirrored by significant rise in serum lactate levels. During this period of time the lowest, although not critical levels of gastric mucosal pH were recorded, suggesting a relative decrease in splanchnic perfusion. Conclusion: Extracorporeal circulation does not significantly compromise splanchnic perfusion. Tonometry is a valuable, non-invasive method of visceral oxygenation monitoring. The first postoperative day is an especially critical time for a cardiac patient—a frequent control of haemodynamic and acid-base balance parameters is absolutely mandatory. © 1997 Elsevier Science B.V.