Blood Pressure-Lowering Effect of Newer Antihyperglycemic Agents (SGLT-2 Inhibitors, GLP-1 Receptor Agonists, and DPP-4 Inhibitors).

The prevalence of arterial hypertension is high in patients with diabetes mellitus (DM). When DM and hypertension coexist, they constitute a dual cardiovascular threat and should be adequately controlled. Novel antihyperglycemic agents, including sodium-glucose co-transporter 2 (SGLT-2) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), and dipeptidyl peptidase-4 (DPP-4) inhibitors, have recently been used in the treatment of DM.

Sodium Glucose Cotransporter 2 (SGLT2) Inhibitors Across the Spectrum of Hypertension.

Sodium glucose cotransporter 2 (SGLT2) inhibitors represent a novel class of oral antihyperglycemic drugs that have been approved over the last decade for the management of type 2 diabetes mellitus. Except the glucose-lowering effects, robust evidence also suggests that SGLT2 inhibitors confer benefits in cardiovascular system. The purpose of this review was to investigate the effects of SGLT2 inhibitors across the spectrum of arterial hypertension.

Computational imaging of aortic vasa vasorum and neovascularization in rabbits using contrast-enhanced intravascular ultrasound: Association with histological analysis.

Objective: Neoangiogenesis is pathophysiologically related to atherosclerotic plaque growth and vulnerability. We examined the in vivo performance of a computational method using contrast-enhanced intravascular ultrasound (CE-IVUS) to detect and quantify aortic wall neovascularization in rabbits. We also compared these findings with histological data.

The impact of financial crisis on coronary artery disease burden in Greece.

Background: Economic crisis poses an immense threat to public health worldwide and has been linked to cardiovascular morbidity and mortality. Greece is facing a distinctive recession over the recent years. However, the exact impact on coronary artery disease (CAD) burden has not been adequately addressed.

Apelin and Visfatin Plasma Levels in Healthy Individuals With High Normal Blood Pressure.

Background: High normal blood pressure (BP; 130-139/85-89 mm Hg) is related with increased cardiovascular (CV) risk compared to normal BP (120-129/80-84 mm Hg) or/and optimal BP (<120/80 mm Hg). Low apelin plasma levels have been associated with arterial hypertension and atherosclerosis, while high visfatin plasma levels may promote vascular inflammation and atherosclerotic plaque destabilization and have been evaluated as a marker for identifying stages of essential hypertension. We sought to compare the apelin and visfatin plasma levels between subjects with high normal BP and subjects with normal or optimal BP matched for age, gender, smoking, and body mass index (BMI).

Impact of atherosclerotic plaque components and their distribution on stent deployment: an intravascular-ultrasound virtual histology observational study.

Background: The aim of this study was to evaluate how the spatial distribution of each plaque element, defined by intravascular-ultrasound virtual histology (IVUS-VH), may affect stent deployment even at high inflation pressures.

Methods: Thirty-two patients undergoing direct percutaneous coronary intervention and IVUS were evaluated. Fifty-two lesions were treated with drug-eluting stents.

Long-term clinical outcomes after percutaneous coronary intervention for chronic total occlusions.

Optimal treatment of chronic total occlusions (CTOs) remains one of the major challenges in interventional cardiology. A number of factors, including both patient clinical conditions and technical procedural considerations, have been identified to affect percutaneous coronary intervention (PCI) success and long-term outcomes, in large multicenter cohorts as well as smaller patient groups. As opposed to patient-centered factors, technical factors can be managed and as a result, a lot of research aims at improving stent technology and imaging guidance, toward enhancing PCI efficiency, in regards to patient safety.

Outcomes in diabetic patients undergoing primary percutaneous coronary intervention for acute anterior myocardial infarction: results from the INFUSE-AMI study.

Objectives: To evaluate the clinical, angiographic, and cardiac magnetic resonance imaging (cMRI) results in patients with and without diabetes mellitus (DM) undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).

Background: DM has been associated with increased mortality in patients with STEMI, yet the mechanisms underpinning this association have not been completely elucidated.

Methods: Overall, 451 patients (51 diabetics) from the INFUSE-AMI trial were studied.

D-dimer levels predict ischemic and hemorrhagic outcomes after acute myocardial infarction: a HORIZONS-AMI biomarker substudy.

D-dimer is a product of cross linked fibrin degradation and is a measure of the amount of fibrin turnover. As such, D-dimer might be of utility in the prediction of both thrombotic and hemorrhagic events. Therefore, the aim of the present study was to evaluate whether elevated D-dimer levels on admission and at discharge could predict subsequent ischemic and hemorrhagic events in patients with acute myocardial infarction (AMI).

Relationship between biomarkers and subsequent bleeding risk in ST-segment elevation myocardial infarction patients treated with paclitaxel-eluting stents: a HORIZONS-AMI substudy.

Major bleeding complications in STEMI patients result in significant mortality, morbidity and healthcare cost. Identification of patients at increased risk of bleeding is therefore essential. New biomarkers might be of incremental value to identify patients at risk for bleeding after primary PCI.

Relationship between biomarkers and subsequent clinical and angiographic restenosis after paclitaxel-eluting stents for treatment of STEMI: a HORIZONS-AMI substudy.

Drug-eluting stents (DES) reduce the incidence of in-stent restenosis (ISR) after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). Whether the use of biomarkers might be of utility to identify patients who remain at risk for DES ISR after primary PCI has never been examined. A total of 26 biomarkers were measured at enrollment and 30 days and analyzed at a central core laboratory in 501 STEMI patients from the HORIZONS-AMI trial.

Volumetric intravascular ultrasound assessment of mechanisms and results of stent expansion in heart transplant patients.

Background: Percutaneous coronary intervention with stent placement for the treatment of patients with cardiac allograft vasculopathy is common, but data regarding stent behavior in this setting is lacking.

Objectives: We investigated mechanisms and potential differences in stent expansion among transplant patients vs. patients with native coronary artery atherosclerotic disease ("controls").

Enhanced stent imaging improves the diagnosis of stent underexpansion and optimizes stent deployment.

Objectives: To investigate the clinical value and diagnostic accuracy of enhanced stent imaging (ESI) as compared with quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS).

Background: ESI is an image acquisition and processing angiography-based software that improves visualization and provides measurements of deployed stents.

Methods: A total of 40 consecutive patients (42 stents) were studied.

Adverse cardiovascular events arising from atherosclerotic lesions with and without angiographic disease progression.

Objectives: The aim of this study was to use angiography and grayscale and intravascular ultrasound-virtual histology to assess coronary lesions that caused events during a median follow-up period of 3.4 years.

Background: Vulnerable plaque-related events are assumed to be the result of substantial progression of insignificant lesions.

Endovascular treatment of infrarenal aortic stenosis: importance of multimodality imaging.

We sought to describe the evolution in imaging and interventional options for endovascular treatment of significant infrarenal aortic stenosis. Balloon angioplasty and stent implantation for infrarenal aortic stenosis has generally required large-sized arterial access sheaths in the past, and was typically guided by visual size assessment. Computerized tomography angiography enables accurate preprocedural assessment of severity and extent of aortic atherosclerosis, degree of calcification, and luminal dimensions at both stenosis and reference sites, and visualizes possible aneurysm.

Angioscopic and virtual histology intravascular ultrasound characteristics of culprit lesion morphology underlying coronary artery thrombosis.

Although rupture of vulnerable plaque with subsequent thrombosis is the most common mechanism of acute coronary syndromes, a significant percentage of patients with acute coronary syndrome may not have plaque rupture. We used angioscopy and virtual histology intravascular ultrasound (VH-IVUS) to investigate the underlying morphology of coronary thrombosis. We correlated the angioscopic diagnosis of coronary thrombosis in 42 lesions (37 patients) with gray-scale and VH-IVUS findings of the underlying plaque.

In-stent restenosis in the drug-eluting stent era.

The introduction of the drug-eluting stent (DES) proved to be an important step forward in reducing rates of restenosis and target lesion revascularization after percutaneous coronary intervention. However, the rapid implementation of DES in standard practice and expansion of the indications for percutaneous coronary intervention to high-risk patients and complex lesions also introduced a new problem: DES in-stent restenosis (ISR), which occurs in 3% to 20% of patients, depending on patient and lesion characteristics and DES type. The clinical presentation of DES ISR is usually recurrent angina, but some patients present with acute coronary syndrome.

Thoracic fluid content and impedance cardiography: a novel and promising noninvasive method for assessing the hemodynamic effects of diuretics in hypertensive patients.

Introduction: Impedance cardiography (ICG) is a reliable, noninvasive method allowing the assessment of the hemodynamic profile in hypertensive patients. The aim of the study was to evaluate the potential hemodynamic effects of diuretics with ICG and examine whether the empiric administration of diuretics actually has a substantial impact on thoracic fluid content (TFC).

Methods: The study population included 248 hypertensive and 68 healthy subjects (35-87 years old) and was divided into 4 groups: group A comprised hypertensive patients under treatment including diuretic; group B consisted of hypertensive patients under treatment without diuretic; group C included untreated hypertensive patients; and group D included healthy subjects.

A new method for assessment of plaque vulnerability based on vasa vasorum imaging, by using contrast-enhanced intravascular ultrasound and differential image analysis.

Background: Increased neovascularization in vasa vasorum and atherosclerotic plaques has recently been identified as a common feature of inflammation and plaque vulnerability. Microbubble contrast agents, which have been used for intravascular imaging, can be used to trace neovascularization. The aim of the study was to detect and evaluate the density of vasa vasorum in non-culprit coronary atherosclerotic plaques of patients with acute coronary syndrome.