Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine, 2003
Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home > March ...
BACKGROUND: In coronary artery bypass grafting (CABG) surgery, there is uncertainty about whether... more BACKGROUND: In coronary artery bypass grafting (CABG) surgery, there is uncertainty about whether the radial artery affects quality of life or costs relative to the saphenous vein. This study compared the cost and quality of life for patients randomized to either radial artery or saphenous vein grafts. METHODS: We analyzed the duration and cost of the index surgery and costs and quality of life (Seattle Angina Questionnaire and Health Utility Index) at 1 year for 726 participants. RESULTS: The 2 treatment groups had similar baseline characteristics. Using the radial artery added approximately 31 minutes to the surgery (from skin incision to skin closure; P Ͻ .001) compared with a saphenous vein graft. There were no significant differences in terms of costs and quality of life after the index hospitalization or at 1 year. CONCLUSIONS: Coronary artery bypass grafting with the radial artery lasts approximately 31 minutes longer than with the saphenous vein. However, costs and the quality of life were not statistically different.
Background: Many patients requiring permanent pacemaker (PPM) or implantable cardiac defibrillato... more Background: Many patients requiring permanent pacemaker (PPM) or implantable cardiac defibrillator (ICD) placement are anticoagulated with warfarin, aspirin (ASA), and clopidogrel for a number of thromboembolic risk indications. The present review sought to evaluate the relationship between continuation of these medications in the peri-procedural period and the incidence of hematoma formation after implantation. Methods: We retrospectively reviewed consecutive patients undergoing PPM and ICD implantation at our hospital from January 2007-2009. All patients on warfarin, aspirin, and clopidogrel were maintained on these medications peri-operatively. We collected data on the use of warfarin at implantation, INR prior to device implantation, use of dual-antiplatelet therapy (DAPT), such as concomitant aspirin and clopidogrel and subsequent formation of hematoma in the peri-procedure period. Results: PPM and ICD implantations were performed in 194 men and six women. The mean age was 73 years old. Fifty eight patients were taking warfarin with an average international normalized ratio of 1.9 ± 0.6; 112 were on ASA, 23 on clopidogrel, and 20 of them on DAPT. Only five patients were on DAPT and warfarin combined at the time of device implantation. Hematomas formed in a total of seven patients (3.5%), five of whom were on DAPT consisting of ASA and clopidogrel (P < 0.0001) while only two of them were on warfarin (P = 0.67). Pocket revision for hematoma evacuation was needed in four patients (2%), three of whom were on DAPT and only one on warfarin. Conclusion: This study suggests that hematoma formation after PPM or ICD implantation is rare, even among those who are anticoagulated. There were more patients with hematoma on DAPT than warfarin therapy and half of these patients with this complication needed pocket revision for evacuation.
The Journal of Heart and Lung Transplantation, 2006
Background: This study was designed to determine whether tissue engineering could be used to redu... more Background: This study was designed to determine whether tissue engineering could be used to reduce ventricular remodeling in a rat model of non-transmural, non-ST-elevation myocardial infarction. Methods: We grafted an acellular 3-dimensional (3D) collagen type 1 scaffold (solid porous foam) onto infarcted myocardium in rats. Three weeks after grafting, the scaffold was integrated into the myocardium and retarded cardiac remodeling by reducing left ventricular (LV) dilation. The LV inner and outer diameters, measured at the equator at zero LV pressure, decreased (p Ͻ 0.05) from 11,040 Ϯ 212 to 9,144 Ϯ 135 m, and 13,469 Ϯ 187 to 11,673 Ϯ 104 m (N ϭ 12), after scaffold transplantation onto infarcted myocardium. The scaffold also shifted the LV pressure-volume curve to the left toward control and induced neo-angiogenesis (700 Ϯ 25 vs 75 Ϯ 11 neo-vessels/cm 2 , N ϭ 5, p Ͻ 0.05). These vessels (75 Ϯ 11%) ranged in diameter from 25 to 100 m and connected to the native coronary vasculature. Systemic treatment with granulocyte-colony stimulating factor (G-CSF), 50 g/kg/day for 5 days immediately after myocardial injury, increased (p Ͻ 0.05) neo-vascular density from 700 Ϯ 25 to 978 Ϯ 57 neo-vessels/cm 2. Conclusions: A 3D collagen type 1 scaffold grafted onto an injured myocardium induced neo-vessel formation and reduced LV remodeling. Treatment with G-CSF further increased the number of vessels in the myocardium, possibly due to mobilization of bone marrow cells.
This study was designed to determine if the thyroid hormone analog 3,5 diiodothyropropionic acid ... more This study was designed to determine if the thyroid hormone analog 3,5 diiodothyropropionic acid (DITPA), now in clinical trials for heart failure, alters endothelial function after myocardial infarction (MI). Three weeks after MI, adult Sprague-Dawley rats were randomly assigned to DITPA (375 microg/100 g subcutaneous) or no treatment of 3 weeks. In MI rats, left ventricular (LV) end-diastolic pressure and LV dP/dt decreased (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). DITPA did not change MAP (87 +/- 10 versus 90 +/- 7 mm Hg) or LV end-diastolic pressure (23 +/- 3 versus 19 +/- 9 mm Hg) but did lower (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) LV dP/dt (4,633 +/- 797 versus 3,650 +/- 1,236 mm Hg/s). In aortic segments from MI rats, DITPA enhanced the acetylcholine dependent vasorelaxation (59 +/- 11% at 10(-4) M, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) and isoproterenol induced vasorelaxation (57 +/- 13% at 10(-4) M, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). The increases in vasorelaxation were blocked with l-NAME and restored with L-arginine. Treatment with DITPA increased (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) eNOS protein content in aortic tissue from sham rats (3.8 +/- 2.8 to 44.5 +/- 7.1 integrated intensity units (II)/microg) and in MI rats (5.3 +/- 3.4 to 28.3 +/- 8.9 II/microg). In endothelial cells, 24 hours&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; treatment with DITPA (10 microM) increased (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01) eNOS protein expression from 22.1 +/- 4.8 to 52.7 +/- 16.8 II/microg protein and DITPA (20 microM) increased eNOS to 49.1+/- 15.2 II/microg protein. The thyroid analog DITPA enhances endothelial nitric oxide and beta-adrenergic-mediated vasorelaxation by increasing nitric oxide in the vasculature.
European Journal of Cardiovascular Nursing, Volume 14, Issue 9, Pages 796, November 2008, Authors... more European Journal of Cardiovascular Nursing, Volume 14, Issue 9, Pages 796, November 2008, Authors:Steven Goldman; Madeline McCarren; Eugene Morkin; Paul Ladenson; Robert Edson; Stuart Warren; Janet Ohm; Hoang Thai; Lori Churby; Jamie Barnhill; Terrence O&amp;#x27;Brien ...
Background: Protection of the heart from ischemic damage by rhEPO had been proven in animal myoca... more Background: Protection of the heart from ischemic damage by rhEPO had been proven in animal myocardial infarction (MI) models. Recent clinical trials testing the effect of rhEPO following PCI have failed to demonstrate either reduction of MI size, or functional improvement. In the US, the time between the onsets of the symptoms and PCI averages about 2 hrs. Legal requirement for informed consent results in further delays of experimental intervention. For instance, in HEBE trial the rhEPO was injected, on average, 3 hrs after successful PCI, in REVEAL trial the time exceeded 4 hrs. We tested the validity of this clinical design in the rat MI model. Methods: In five groups of 2-month old male Wistar rats, the left descending coronary artery was occluded either by a permanent or by a temporary ligature. After 2 hrs of occlusion, temporary ligatures were released and coronary perfusion was restored. rhEPO (3000U/kg) or saline were injected intraperitoneally either immediately after reperfusion, or 4 hours after reperfusion, or 6 hrs after permanent coronary occlusion. 24 hrs following coronary occlusion rats were euthanized and MI size was measured histologically. Results: MI size (42 6 2% of the area at risk in untreated animals) was significantly smaller (19 6 2% of the area at risk, p!0.0001) in animals treated by rhEPO at the beginning of reperfusion, but was not altered by rhEPO given 4 hrs after beginning of reperfusion or 6 hrs after permanent coronary occlusion. Conclusion: In a rat model of ischemia-reperfusion the rhEPO effectively reduced MI size only when applied immediately following reperfusion. The cardioprotective potential of rhEPO in the treatment of acute MI in the recent clinical trials may not be unveiled due to the prolonged time required between coronary reperfusion and rhEPO administration. 203
echocardiography, antioxidant enzyme activities through superoxide dismutase (SOD) and catalase (... more echocardiography, antioxidant enzyme activities through superoxide dismutase (SOD) and catalase (CAT) and oxidative stress through carbonyl groups. Results: Ejection fraction (EF) decreased in MI group (59 6 6) vs S (71 6 2) (p ! 0.01) and was preserved in the MIT (62 6 9) vs ST (69 6 8). Antioxidant enzyme activity of SOD (U/mg protein) was not different among experimental groups S (9.0 6 1), MI (6.51 6 3.8), ST (10.63 6 2.32), MIT (6.0 6 3.6). CAT activity (pmol/mg protein) decreased in MI (33.87 6 6.39) vs S (73.01 6 19) (p ! 0.001) but it was up regulated in MIT group (38.73 6 8.1) vs ST (24.59 6 6.7). Protein damage assessed through carbonyl groups (nmol/mg protein) was not different among groups S (4 6 1.5), MI (3.7 6 1.7), ST (7.8 6 3.5), MIT (6.58 6 2.4). Conclusions: Unchanged cardiac function 48h post-experimental MI was associated with relative absence of oxidative injury. However, early decrease in CAT activity (less evident in MI animals receiving cells early post-MI) may signal later development of cardiac remodeling process through peroxide pathways, which could subsequently be quenched by cellular therapy.
The Department of Veterans Affairs (VA) Cooperative Studies Program (CSP) initiated a multi-site ... more The Department of Veterans Affairs (VA) Cooperative Studies Program (CSP) initiated a multi-site randomized trial (CSP 474) to determine graph patency between radial artery or saphenous vein grafts in coronary artery bypass surgery (CABG). In this paper, we describe the study and compare participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; baseline characteristics to non-participants who received CABG surgery in the VA. We identified our participants in the VA administrative databases along with all other CABG patients who did not have a concomitant valve procedure between FY2003 and FY2008. We extracted demographic, clinical information and organizational information at the time of the surgery from the databases. We conducted multiple logistic regression to determine characteristics associated with participation at three levels: between participants and non-participants within participating sites, between participating sites and non-participating sites, between participants and all non-participants. Enrollment ended in early 2008. Participants were similar to non-participants across many parameters. Likewise, participating sites were also quite similar to non-participating sites, although participating sites had a higher volume of CABG surgery, a lower percentage of CABG patients with a prior inpatient mental health admission than non-participating sites. After controlling for site differences, CSP 474 participants were younger and had fewer co-morbid conditions than non-participants. Participants were significantly younger than non-participants. Participants also had lower rates of some cardiac-related illness including, congestive heart failure, peripheral vascular disease, and cerebrovascular disease than non-participants.
Background— In animal studies and a pilot trial in patients with congestive heart failure, the th... more Background— In animal studies and a pilot trial in patients with congestive heart failure, the thyroid hormone analog 3,5 diiodothyropropionic acid (DITPA) had beneficial hemodynamic effects. Methods and Results— This was a phase II multicenter, randomized, placebo-controlled, double-blind trial of New York Heart Association class II to IV congestive heart failure patients randomized (2:1) to DITPA or placebo and treated for 6 months. The study enrolled 86 patients (n=57 to DITPA, n=29 to placebo). The primary objective was to assess the effect of DITPA on a composite congestive heart failure end point that classifies patients as improved, worsened, or unchanged based on symptom changes and morbidity/mortality. DITPA was poorly tolerated, which obscured the interpretation of congestive heart failure-specific effects. Fatigue and gastrointestinal complaints, in particular, were more frequent in the DITPA group. DITPA increased cardiac index (by 18%) and decreased systemic vascular re...
Background— This study was designed to determine the effects of pretreatment with an angiotensin ... more Background— This study was designed to determine the effects of pretreatment with an angiotensin receptor blocker on left ventricular (LV) function and remodeling during acute myocardial infarction (MI). Methods and Results— Sprague-Dawley rats were pretreated with candesartan (10 mg · kg −1 · d −1 ) for 2 weeks and studied at 1, 3, and 6 minutes after MI. Compared with untreated rats, pretreatment with candesartan lowered ( P <0.05) LV systolic pressure and the first derivative of LV pressure with respect to time but did not change LV end-diastolic pressure or improve LV regional function. With candesartan pretreatment, LV fractional shortening and ejection fraction increased ( P <0.05) by 37% and 28%, and LV chamber dilation was attenuated ( P <0.05). At 6 minutes after MI, LV endothelial nitric oxide synthase decreased in the infarcted and noninfarcted wall 47% ( P =0.04) and 70% ( P =0.002), and constitutive microtubulin increased 260% ( P =0.0005) and 111% ( P =0.003)....
The efficacy of amiodarone used in combination with a pacemaker cardioverter defibrillator (PCD) ... more The efficacy of amiodarone used in combination with a pacemaker cardioverter defibrillator (PCD) to decrease episodes of ventricular tachycardia and subsequent PCD shocks is not clear. We examined a retrospective registry of 82 patients with PCD implantation to define the efficacy of amiodarone treatment. We compared patients treated with amiodarone (for 24 consecutive months without interruption) versus no amiodarone. In patients treated with amiodarone there was a 3-fold increase (p = 0.02) in PCD shocks; in patients not on beta-blockers, amiodarone resulted in a 6-fold increase (p < 0.05) in PCD shocks. Patients with a left ventricular ejection fraction >30% on amiodarone and patients <72 years old had increases (p < 0.05) in PCD shocks. In conclusion, patients treated with amiodarone had more PCD shocks than those not treated. These findings are unexpected and merit a prospective study.
Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine, 2003
Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home > March ...
BACKGROUND: In coronary artery bypass grafting (CABG) surgery, there is uncertainty about whether... more BACKGROUND: In coronary artery bypass grafting (CABG) surgery, there is uncertainty about whether the radial artery affects quality of life or costs relative to the saphenous vein. This study compared the cost and quality of life for patients randomized to either radial artery or saphenous vein grafts. METHODS: We analyzed the duration and cost of the index surgery and costs and quality of life (Seattle Angina Questionnaire and Health Utility Index) at 1 year for 726 participants. RESULTS: The 2 treatment groups had similar baseline characteristics. Using the radial artery added approximately 31 minutes to the surgery (from skin incision to skin closure; P Ͻ .001) compared with a saphenous vein graft. There were no significant differences in terms of costs and quality of life after the index hospitalization or at 1 year. CONCLUSIONS: Coronary artery bypass grafting with the radial artery lasts approximately 31 minutes longer than with the saphenous vein. However, costs and the quality of life were not statistically different.
Background: Many patients requiring permanent pacemaker (PPM) or implantable cardiac defibrillato... more Background: Many patients requiring permanent pacemaker (PPM) or implantable cardiac defibrillator (ICD) placement are anticoagulated with warfarin, aspirin (ASA), and clopidogrel for a number of thromboembolic risk indications. The present review sought to evaluate the relationship between continuation of these medications in the peri-procedural period and the incidence of hematoma formation after implantation. Methods: We retrospectively reviewed consecutive patients undergoing PPM and ICD implantation at our hospital from January 2007-2009. All patients on warfarin, aspirin, and clopidogrel were maintained on these medications peri-operatively. We collected data on the use of warfarin at implantation, INR prior to device implantation, use of dual-antiplatelet therapy (DAPT), such as concomitant aspirin and clopidogrel and subsequent formation of hematoma in the peri-procedure period. Results: PPM and ICD implantations were performed in 194 men and six women. The mean age was 73 years old. Fifty eight patients were taking warfarin with an average international normalized ratio of 1.9 ± 0.6; 112 were on ASA, 23 on clopidogrel, and 20 of them on DAPT. Only five patients were on DAPT and warfarin combined at the time of device implantation. Hematomas formed in a total of seven patients (3.5%), five of whom were on DAPT consisting of ASA and clopidogrel (P < 0.0001) while only two of them were on warfarin (P = 0.67). Pocket revision for hematoma evacuation was needed in four patients (2%), three of whom were on DAPT and only one on warfarin. Conclusion: This study suggests that hematoma formation after PPM or ICD implantation is rare, even among those who are anticoagulated. There were more patients with hematoma on DAPT than warfarin therapy and half of these patients with this complication needed pocket revision for evacuation.
The Journal of Heart and Lung Transplantation, 2006
Background: This study was designed to determine whether tissue engineering could be used to redu... more Background: This study was designed to determine whether tissue engineering could be used to reduce ventricular remodeling in a rat model of non-transmural, non-ST-elevation myocardial infarction. Methods: We grafted an acellular 3-dimensional (3D) collagen type 1 scaffold (solid porous foam) onto infarcted myocardium in rats. Three weeks after grafting, the scaffold was integrated into the myocardium and retarded cardiac remodeling by reducing left ventricular (LV) dilation. The LV inner and outer diameters, measured at the equator at zero LV pressure, decreased (p Ͻ 0.05) from 11,040 Ϯ 212 to 9,144 Ϯ 135 m, and 13,469 Ϯ 187 to 11,673 Ϯ 104 m (N ϭ 12), after scaffold transplantation onto infarcted myocardium. The scaffold also shifted the LV pressure-volume curve to the left toward control and induced neo-angiogenesis (700 Ϯ 25 vs 75 Ϯ 11 neo-vessels/cm 2 , N ϭ 5, p Ͻ 0.05). These vessels (75 Ϯ 11%) ranged in diameter from 25 to 100 m and connected to the native coronary vasculature. Systemic treatment with granulocyte-colony stimulating factor (G-CSF), 50 g/kg/day for 5 days immediately after myocardial injury, increased (p Ͻ 0.05) neo-vascular density from 700 Ϯ 25 to 978 Ϯ 57 neo-vessels/cm 2. Conclusions: A 3D collagen type 1 scaffold grafted onto an injured myocardium induced neo-vessel formation and reduced LV remodeling. Treatment with G-CSF further increased the number of vessels in the myocardium, possibly due to mobilization of bone marrow cells.
This study was designed to determine if the thyroid hormone analog 3,5 diiodothyropropionic acid ... more This study was designed to determine if the thyroid hormone analog 3,5 diiodothyropropionic acid (DITPA), now in clinical trials for heart failure, alters endothelial function after myocardial infarction (MI). Three weeks after MI, adult Sprague-Dawley rats were randomly assigned to DITPA (375 microg/100 g subcutaneous) or no treatment of 3 weeks. In MI rats, left ventricular (LV) end-diastolic pressure and LV dP/dt decreased (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). DITPA did not change MAP (87 +/- 10 versus 90 +/- 7 mm Hg) or LV end-diastolic pressure (23 +/- 3 versus 19 +/- 9 mm Hg) but did lower (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) LV dP/dt (4,633 +/- 797 versus 3,650 +/- 1,236 mm Hg/s). In aortic segments from MI rats, DITPA enhanced the acetylcholine dependent vasorelaxation (59 +/- 11% at 10(-4) M, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) and isoproterenol induced vasorelaxation (57 +/- 13% at 10(-4) M, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). The increases in vasorelaxation were blocked with l-NAME and restored with L-arginine. Treatment with DITPA increased (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) eNOS protein content in aortic tissue from sham rats (3.8 +/- 2.8 to 44.5 +/- 7.1 integrated intensity units (II)/microg) and in MI rats (5.3 +/- 3.4 to 28.3 +/- 8.9 II/microg). In endothelial cells, 24 hours&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; treatment with DITPA (10 microM) increased (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01) eNOS protein expression from 22.1 +/- 4.8 to 52.7 +/- 16.8 II/microg protein and DITPA (20 microM) increased eNOS to 49.1+/- 15.2 II/microg protein. The thyroid analog DITPA enhances endothelial nitric oxide and beta-adrenergic-mediated vasorelaxation by increasing nitric oxide in the vasculature.
European Journal of Cardiovascular Nursing, Volume 14, Issue 9, Pages 796, November 2008, Authors... more European Journal of Cardiovascular Nursing, Volume 14, Issue 9, Pages 796, November 2008, Authors:Steven Goldman; Madeline McCarren; Eugene Morkin; Paul Ladenson; Robert Edson; Stuart Warren; Janet Ohm; Hoang Thai; Lori Churby; Jamie Barnhill; Terrence O&amp;#x27;Brien ...
Background: Protection of the heart from ischemic damage by rhEPO had been proven in animal myoca... more Background: Protection of the heart from ischemic damage by rhEPO had been proven in animal myocardial infarction (MI) models. Recent clinical trials testing the effect of rhEPO following PCI have failed to demonstrate either reduction of MI size, or functional improvement. In the US, the time between the onsets of the symptoms and PCI averages about 2 hrs. Legal requirement for informed consent results in further delays of experimental intervention. For instance, in HEBE trial the rhEPO was injected, on average, 3 hrs after successful PCI, in REVEAL trial the time exceeded 4 hrs. We tested the validity of this clinical design in the rat MI model. Methods: In five groups of 2-month old male Wistar rats, the left descending coronary artery was occluded either by a permanent or by a temporary ligature. After 2 hrs of occlusion, temporary ligatures were released and coronary perfusion was restored. rhEPO (3000U/kg) or saline were injected intraperitoneally either immediately after reperfusion, or 4 hours after reperfusion, or 6 hrs after permanent coronary occlusion. 24 hrs following coronary occlusion rats were euthanized and MI size was measured histologically. Results: MI size (42 6 2% of the area at risk in untreated animals) was significantly smaller (19 6 2% of the area at risk, p!0.0001) in animals treated by rhEPO at the beginning of reperfusion, but was not altered by rhEPO given 4 hrs after beginning of reperfusion or 6 hrs after permanent coronary occlusion. Conclusion: In a rat model of ischemia-reperfusion the rhEPO effectively reduced MI size only when applied immediately following reperfusion. The cardioprotective potential of rhEPO in the treatment of acute MI in the recent clinical trials may not be unveiled due to the prolonged time required between coronary reperfusion and rhEPO administration. 203
echocardiography, antioxidant enzyme activities through superoxide dismutase (SOD) and catalase (... more echocardiography, antioxidant enzyme activities through superoxide dismutase (SOD) and catalase (CAT) and oxidative stress through carbonyl groups. Results: Ejection fraction (EF) decreased in MI group (59 6 6) vs S (71 6 2) (p ! 0.01) and was preserved in the MIT (62 6 9) vs ST (69 6 8). Antioxidant enzyme activity of SOD (U/mg protein) was not different among experimental groups S (9.0 6 1), MI (6.51 6 3.8), ST (10.63 6 2.32), MIT (6.0 6 3.6). CAT activity (pmol/mg protein) decreased in MI (33.87 6 6.39) vs S (73.01 6 19) (p ! 0.001) but it was up regulated in MIT group (38.73 6 8.1) vs ST (24.59 6 6.7). Protein damage assessed through carbonyl groups (nmol/mg protein) was not different among groups S (4 6 1.5), MI (3.7 6 1.7), ST (7.8 6 3.5), MIT (6.58 6 2.4). Conclusions: Unchanged cardiac function 48h post-experimental MI was associated with relative absence of oxidative injury. However, early decrease in CAT activity (less evident in MI animals receiving cells early post-MI) may signal later development of cardiac remodeling process through peroxide pathways, which could subsequently be quenched by cellular therapy.
The Department of Veterans Affairs (VA) Cooperative Studies Program (CSP) initiated a multi-site ... more The Department of Veterans Affairs (VA) Cooperative Studies Program (CSP) initiated a multi-site randomized trial (CSP 474) to determine graph patency between radial artery or saphenous vein grafts in coronary artery bypass surgery (CABG). In this paper, we describe the study and compare participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; baseline characteristics to non-participants who received CABG surgery in the VA. We identified our participants in the VA administrative databases along with all other CABG patients who did not have a concomitant valve procedure between FY2003 and FY2008. We extracted demographic, clinical information and organizational information at the time of the surgery from the databases. We conducted multiple logistic regression to determine characteristics associated with participation at three levels: between participants and non-participants within participating sites, between participating sites and non-participating sites, between participants and all non-participants. Enrollment ended in early 2008. Participants were similar to non-participants across many parameters. Likewise, participating sites were also quite similar to non-participating sites, although participating sites had a higher volume of CABG surgery, a lower percentage of CABG patients with a prior inpatient mental health admission than non-participating sites. After controlling for site differences, CSP 474 participants were younger and had fewer co-morbid conditions than non-participants. Participants were significantly younger than non-participants. Participants also had lower rates of some cardiac-related illness including, congestive heart failure, peripheral vascular disease, and cerebrovascular disease than non-participants.
Background— In animal studies and a pilot trial in patients with congestive heart failure, the th... more Background— In animal studies and a pilot trial in patients with congestive heart failure, the thyroid hormone analog 3,5 diiodothyropropionic acid (DITPA) had beneficial hemodynamic effects. Methods and Results— This was a phase II multicenter, randomized, placebo-controlled, double-blind trial of New York Heart Association class II to IV congestive heart failure patients randomized (2:1) to DITPA or placebo and treated for 6 months. The study enrolled 86 patients (n=57 to DITPA, n=29 to placebo). The primary objective was to assess the effect of DITPA on a composite congestive heart failure end point that classifies patients as improved, worsened, or unchanged based on symptom changes and morbidity/mortality. DITPA was poorly tolerated, which obscured the interpretation of congestive heart failure-specific effects. Fatigue and gastrointestinal complaints, in particular, were more frequent in the DITPA group. DITPA increased cardiac index (by 18%) and decreased systemic vascular re...
Background— This study was designed to determine the effects of pretreatment with an angiotensin ... more Background— This study was designed to determine the effects of pretreatment with an angiotensin receptor blocker on left ventricular (LV) function and remodeling during acute myocardial infarction (MI). Methods and Results— Sprague-Dawley rats were pretreated with candesartan (10 mg · kg −1 · d −1 ) for 2 weeks and studied at 1, 3, and 6 minutes after MI. Compared with untreated rats, pretreatment with candesartan lowered ( P <0.05) LV systolic pressure and the first derivative of LV pressure with respect to time but did not change LV end-diastolic pressure or improve LV regional function. With candesartan pretreatment, LV fractional shortening and ejection fraction increased ( P <0.05) by 37% and 28%, and LV chamber dilation was attenuated ( P <0.05). At 6 minutes after MI, LV endothelial nitric oxide synthase decreased in the infarcted and noninfarcted wall 47% ( P =0.04) and 70% ( P =0.002), and constitutive microtubulin increased 260% ( P =0.0005) and 111% ( P =0.003)....
The efficacy of amiodarone used in combination with a pacemaker cardioverter defibrillator (PCD) ... more The efficacy of amiodarone used in combination with a pacemaker cardioverter defibrillator (PCD) to decrease episodes of ventricular tachycardia and subsequent PCD shocks is not clear. We examined a retrospective registry of 82 patients with PCD implantation to define the efficacy of amiodarone treatment. We compared patients treated with amiodarone (for 24 consecutive months without interruption) versus no amiodarone. In patients treated with amiodarone there was a 3-fold increase (p = 0.02) in PCD shocks; in patients not on beta-blockers, amiodarone resulted in a 6-fold increase (p < 0.05) in PCD shocks. Patients with a left ventricular ejection fraction >30% on amiodarone and patients <72 years old had increases (p < 0.05) in PCD shocks. In conclusion, patients treated with amiodarone had more PCD shocks than those not treated. These findings are unexpected and merit a prospective study.
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