Is thrombosis a contributor to heart failure pathophysiology? Possible mechanisms, therapeutic opportunities, and clinical investigation challenges.

Thrombotic events (coronary thrombosis, venous thromboembolism, intraventricular thrombosis, intracranial and systemic thromboembolism) occur frequently in patients with heart failure. These events may be precipitated by several mechanisms including hypercoagulability through enhancement of procoagulant reactions, impairment of the protein C pathway, protease activated receptor (PAR) activation, adenosine-mediated thrombosis, or neurohormonal activation; stasis secondary to low cardiac output; and endothelial dysfunction from neurohormonal activation or systemic inflammation. Pathophysiologic evidence and analyses of retrospective data support the hypothesis that antithrombotic agents may improve outcomes in patients with heart failure.

Esomeprazole for prevention and resolution of upper gastrointestinal symptoms in patients treated with low-dose acetylsalicylic acid for cardiovascular protection: the OBERON trial.

Although low-dose acetylsalicylic acid (ASA) is recommended for prevention of cardiovascular events in at-risk patients, its long-term use can be associated with the risk of peptic ulcer and upper gastrointestinal (GI) symptoms that may impact treatment compliance. This prespecified secondary analysis of the OBERON study (NCT00441727) determined the efficacy of esomeprazole for prevention/resolution of low-dose ASA-associated upper GI symptoms. A post hoc analysis of predictors of symptom prevention/resolution was also conducted.

Changes in diagnosing non-ST-segment elevation myocardial infarction after the introduction of a new high-sensitivity cardiac troponin T assay: a single-centre experience.

Background: Cardiac troponins are the most sensitive and specific biochemical markers of myocardial injury and with the new high-sensitivity troponin methods very minor injuries of the heart muscle can be detected. The introduction of high-sensitivity assays has facilitated reference range adjustments and a revised cut-off point for myocardial infarction (MI) due to an improved performance in the lower concentration range. The objective of this study was to investigate whether implementing a high-sensitivity cardiac troponin T (hs-cTnT) assay with subsequent lowering of the cut-off point changed the hospital evaluation and diagnosis of acute non-ST-segment elevation myocardial infarction (NSTEMI) in a general hospital population.

Impaired endothelial function in persons with obstructive sleep apnoea: impact of obesity.

Objective: Obstructive sleep apnoea (OSA) and obesity are both associated with endothelial dysfunction, which precedes the development of atherosclerosis. As obesity is highly prevalent in OSA, we wanted to test the hypothesis that OSA is associated with endothelial dysfunction independently of obesity.

Design: Cross-sectional, population-based study.

2-h postchallenge plasma glucose predicts cardiovascular events in patients with myocardial infarction without known diabetes mellitus.

Background And Purpose: The incidence of cardiovascular events remains high in patients with myocardial infarction (MI) despite advances in current therapies. New and better methods for identifying patients at high risk of recurrent cardiovascular (CV) events are needed. This study aimed to analyze the predictive value of an oral glucose tolerance test (OGTT) in patients with acute myocardial infarction without known diabetes mellitus (DM).

Echogenicity of the carotid intima-media complex and cardiovascular risk factors.

Introduction: Increased carotid intima-media thickness (IMT) has been associated with increased risk of myocardial infarction (MI) and stroke. A measure of echogenicity, the grey scale median (GSM), has been shown to be inversely correlated with cardiovascular risk factors and to be predictive of mortality in a community-based cohort. We assessed the factors associated with carotid IM-GSM in younger, non-diabetic patients with a recent MI.

Myocardial infarction with normal coronary arteries is common and associated with normal findings on cardiovascular magnetic resonance imaging: results from the Stockholm Myocardial Infarction with Normal Coronaries study.

Objectives: Myocardial infarction with angiographically normal coronary arteries (MINCA) is an important subtype of myocardial infarction; however, the prevalence, underlying pathophysiology, prognosis and optimal management of this condition are still largely unknown. Cardiovascular magnetic resonance (CMR) imaging has the potential to clarify the underlying pathology in patients with MINCA. The objective of this study was to investigate the diagnostic value of CMR imaging in this group of patients.

Relations of serum COMP to cardiovascular risk factors and endothelial function in patients with rheumatoid arthritis treated with methotrexate and TNF-α inhibitors.

Objective: To examine whether serum level of cartilage oligomeric matrix protein (S-COMP) is related to methotrexate (MTX) or to MTX and tumor necrosis factor-α (TNF-α) combination treatment for rheumatoid arthritis (RA); and to investigate whether S-COMP is related to cardiovascular risk factors including endothelial dysfunction and level of anticitrullinated protein antibodies (ACPA) in patients with RA.

Methods: Clinical and laboratory measures, including S-COMP and reactive hyperemic index (RHI), were examined in 55 consecutive patients with RA starting with either MTX (n = 34) or MTX and anti-TNF-α treatment (n = 21) at baseline, and after 6 weeks and 6 months.

Results: S-COMP was similar in the 2 treatment regimens during followup.

Ultrasound and radiology surrogate endpoints in pharmacological studies.

Cardiovascular studies investigating therapeutic intervention with clinical endpoints are costly due to the need for considerable duration and large number of patients, or both. Therefore, for evaluation of novel cardiovascular drug efficacy, surrogate endpoints are used. Cardiovascular imaging endpoints have proven their worth.

Prognostic value of combining high sensitive troponin T and N-terminal pro B-type natriuretic peptide in chest pain patients with no persistent ST-elevation.

The aim was to examine whether high sensitive troponin T (Hs-TnT) is better than conventional troponins to risk stratify chest pain patients, in particular when applying early serial measurements or combining with natriuretic peptides. Samples were obtained on admission and after 2 h in 231 chest pain patients who were followed for a median time of 22 months. Troponin levels were determined by Hs-TnT, conventional TnT (Roche Diagnostics) and troponin I (Beckman Coulter) assays.

Risk factors for myocardial infarction with normal coronary arteries and myocarditis compared with myocardial infarction with coronary artery stenosis.

The interest and awareness of myocardial infarction with normal coronary arteries (MINCA) have increased recently due to the frequent use of coronary angiography, the description of Takotsubo stress cardiomyopathy, and new sensitive troponin analyses. The prevalence of MINCA in all patients with myocardial infarction (MI) was registered during a 3-month period in the Stockholm metropolitan area in Sweden. The results showed that MINCA is more common than previously thought (7%) and affecting one third of every woman with MI.

Anti-CCP and RF IgM: predictors of impaired endothelial function in rheumatoid arthritis patients.

Objective: To determine whether the presence of anti-cyclic citrullinated peptide (anti-CCP) antibodies and rheumatoid factor immunoglobulin M (RF IgM) is associated with endothelial dysfunction in patients with rheumatoid arthritis (RA).

Methods: We studied the presence of anti-CCP antibodies and RF IgM and endothelial function in terms of the reactive hyperaemic index (RHI) in 53 consecutive RA patients. Endothelial function was measured by using a finger plethysmograph.

Physical exertion may cause high troponin levels.

It is important to measure troponin levels when acute myocardial infarct is suspected. Many other factors that affect the heart can cause an increase in troponin levels, for example extreme physical exertion. Recent studies have shown that more normal physical activity can also lead to increase in troponin levels in healthy individuals.

The course of D-dimer, high-sensitivity C-reactive protein and pro-B-type natriuretic peptide in patients with non-ST-elevation myocardial infarction.

Background: Elevated levels of high-sensitivity C-reactive protein (hs-CRP), B-type natriuretic peptide (BNP), and D-dimer each are associated with higher rates of death and recurrent ischemic events in patients with acute myocardial infarction (AMI). The aim of this study was to examine the dynamic course of D-dimer, hs-CRP, and pro-BNP in patients with Non-ST-Elevation Myocardial Infarction (NSTEMI).

Methods: The study group consisted of 82 patients presenting with symptoms suggestive of acute coronary syndrome (ACS).