Effect of atorvastatin on exercise-induced myocardial ischemia in patients with stable angina pectoris.

To investigate whether marked and sustained lipid-lowering in subjects with stable angina pectoris and dyslipidemia reduces exercise-induced myocardial ischemia, 17 subjects were treated with dose-adjusted atorvastatin over 1 year and underwent serial evaluation of exercise electrocardiographic ischemic parameters, serum biomarkers, and brachial artery endothelial function. Endothelial function improved progressively and C-reactive protein, P-selectin, and tissue plasminogen activator inhibitor levels decreased, but there was no decrease in exercise electrocardiographic ischemia.

Contribution of apo CIII reduction to the greater effect of 12-week micronized fenofibrate than atorvastatin therapy on triglyceride levels and LDL size in dyslipidemic patients.

Background: Apolipoprotein (apo) CIII plays an important role in the catabolism of triglyceride-rich lipoproteins as it is a potent inhibitor of lipoprotein lipase (LPL). A low LPL activity has been simultaneously associated with hypertriglyceridemia, low HDL cholesterol and with small LDL particles.

Aim: To compare the effects of a 12-week treatment with micronized fenofibrate (200 mg) versus atorvastatin (10 mg) on apo CIII and lipoprotein-lipid levels including LDL size.

Potential contribution of metformin to the management of cardiovascular disease risk in patients with abdominal obesity, the metabolic syndrome and type 2 diabetes.

With an evolving landscape of a growing number of obese and/or type 2 diabetic patients in our affluent population, the metabolic syndrome has become a major issue because of its impact on cardiovascular disease risk. In this regard, although it is appropriate to aim at a better glycaemic control in type 2 diabetic patients, hyperglycaemia does not appear to be the main culprit responsible for the markedly increased cardiovascular disease risk in this population. Rather, studies have suggested that a cluster of metabolic abnormalities, which includes an atherogenic dyslipidaemic state, an impaired glucose/insulin homeostasis, and a pro-thrombotic and inflammatory profile, substantially increases the risk of coronary heart disease in type 2 diabetic patients in a manner which is partly independent of glycaemic control.

Determinants of stroke after coronary artery bypass grafting.

Objectives: Cerebrovascular accidents (CVA) after CABG are deleterious complications whose prevention remains poorly defined. The aim of this study was to identify the determinants for CVA after CABG.

Methods: Nine thousand nine hundred and sixteen patients underwent CABG at our institution from January 1992 to June 2002.

Delayed treatment of contained blunt traumatic aortic rupture: a case of rupture treated by endoprosthesis.

A 45-year-old man sustained an intracerebral frontal hematoma and a contained aortic isthmic rupture in a head-on automobile collision. Due to the intracerebral hemorrhage, open repair was contraindicated. Treatment with a stent graft was selected but delayed until the next morning, because the correct stent size was unavailable.

Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacement.

Background: The prosthesis used for aortic valve replacement (AVR) can be too small in relation to body size, thus causing valve prosthesis-patient mismatch (PPM) and abnormally high transvalvular pressure gradients. This study examined if there is a relation between PPM and short-term mortality after operation.

Methods And Results: The indexed valve effective orifice area (EOA) was estimated for each type and size of prosthesis being implanted in 1266 consecutive patients and used to define PPM as not clinically significant if >0.

Preclinical diabetic cardiomyopathy: relation of left ventricular diastolic dysfunction to cardiac autonomic neuropathy in men with uncomplicated well-controlled type 2 diabetes.

Diabetic cardiomyopathy is an ill-defined entity. This study was designed to explore the possible association between left ventricular diastolic dysfunction (LVDD) and cardiac autonomic neuropathy (CAN) independently from metabolic control. Three groups of 10 age-matched men each with well-controlled type 2 diabetes were studied: (1) subjects with normal diastolic function, (2) subjects with LVDD characterized by impaired LV relaxation, and (3) subjects with a more severe form of LVDD characterized by a pseudonormalized pattern of LV filling.

Does moderate mitral regurgitation impact early or mid-term clinical outcome in patients undergoing isolated aortic valve replacement for aortic stenosis?

Objective: The early and mid-term impact of functional mitral regurgitation (MR) in patients undergoing isolated aortic valve replacement (AVR) for aortic stenosis remains unresolved.

Method: Through our institutional databank, using a case-match study, we identified 58 patients with MR grades 0-1 and 58 patients with MR grades 2-3 (patients matched for sex, age, ejection fraction (EF), NYHA, diabetes, and CVA). Data were collected prospectively (mean duration of follow-up: 3.

Complex transradial three vessel brachytherapy in a single session.

Background: We report the case of a patient who underwent transradial brachytherapy in 3 different coronary vessels during a single session. She initially presented with unstable angina 4 months after the index procedure; control angiography showed severe and diffuse in-stent restenosis in the LAD, Cx and Mg arteries.

Methods: After successful dilatation of the three vessels, we performed vascular brachytherapy using the Novoste Beta-Rail system and a 60 mm length source train of 90Sr/Y radioactive seeds.

Modulation and roles of the endothelins in the pathophysiology of pulmonary embolism.

Recent research on the endothelins (ETs) and their pathways in acute pulmonary embolism (APE) has led to significant advances in the understanding of this disease. ETs are potent vasoconstrictors and bronchoconstrictors found abundantly in the lung and can be released by stimuli such as endothelial injury, hypoxia, or thrombin, a key product in the coagulation cascade. Many studies using different approaches and methods of inducing pulmonary embolization, both in vitro and in vivo in various species, have mostly shown that ETs play an important role in the pathophysiology of APE.

Eating behaviors and indexes of body composition in men and women from the Québec family study.

Objective: To put into relationship the dietary and anthropometric profile of men and women with their eating behaviors (cognitive dietary restraint, disinhibition, and susceptibility to hunger) and to assess whether gender and obesity status influence these associations.

Research Methods And Procedures: Anthropometric measurements (including visceral adipose tissue accumulation), dietary profile (3-day food record), and eating behaviors (Three-Factor Eating Questionnaire) were determined in a sample of 244 men and 352 women.

Results: Women had significantly higher cognitive dietary restraint and disinhibition scores than men (p < 0.

Left ventricular longitudinal shortening in patients with aortic stenosis: relationship with symptomatic status.

Background And Aim Of The Study: Symptomatic status in aortic stenosis is not always related to hemodynamic severity as estimated by the aortic valve effective orifice area (AVA), and other factors may be involved. It has been seen previously that, whilst ejection fraction is preserved, left ventricular (LV) longitudinal shortening may be selectively decreased in aortic stenosis, and hypothesized that this might be a marker of subendocardial ischemia as subendocardial myocardial fibers are oriented longitudinally. The present study examined the possible relationship between LV longitudinal shortening and symptoms in patients with aortic stenosis.

What induces the warm-up ischemia/angina phenomenon: exercise or myocardial ischemia?

Background: The relation of the warm-up ischemia phenomenon to the presence and intensity of initial myocardial ischemia is unclear. We sought to determine whether the warm-up ischemia phenomenon requires initial myocardial ischemia or can be induced by exercise without ischemia and whether there is a relation between the intensity of initial ischemia and the attenuation of ischemia on reexercise.

Methods And Results: Twelve subjects with exertional myocardial ischemia performed 2 exercise ECG tests (1 and 2) at a +/-10-minute interval on 3 occasions (A, B, C) 1 month apart.

Rescue therapy with methylene blue in systemic inflammatory response syndrome after cardiac surgery.

Severe unresponsive vasoplegia syndrome following cardiopulmonary bypass is rare. The authors report a case of severe vasoplegia, unresponsive to conventional treatment three days following cardiopulmonary bypass. A single intravenous bolus (2 mg/kg) of methylene blue was administered with normalization of the peripheral resistance.

The relationships between atopy, rhinitis and asthma: pathophysiological considerations.

Purpose Of Review: A close relationship has been described between atopy, allergic rhinitis and asthma. The purpose of this work was to review recent data that have become available on the interactions between these conditions and the ways in which they influence one another.

Recent Findings: Recent findings support previous observations suggesting that atopic dermatitis and rhinitis often accompany or precede the development of asthma.

Prevalence of metabolic alterations predictive of cardiovascular disease risk in the Québec population.

Background: It is well established that cardiovascular diseases (CVD) are the most important cause of morbidity and mortality in North America and in industrialized countries. Furthermore, the presence of CVD risk factors is widespread in Canada, and two-thirds of adult Canadians present at least one traditional risk factor for CVD.

Objective: To quantify the prevalence of metabolic alterations predictive of an increased risk of CVD in a representative sample of the Québec population.

PPAR-gamma activation mediates adipose depot-specific effects on gene expression and lipoprotein lipase activity: mechanisms for modulation of postprandial lipemia and differential adipose accretion.

This study sought to determine whether the adipose depot-specific (subcutaneous [SF] vs. visceral [VF]) action of peroxisome proliferator-activated receptor-gamma (PPAR-gamma) agonists on fat deposition extends to the expression of lipoprotein lipase (LPL) and other key adipose lipid metabolism genes, and whether changes in LPL impact triglyceridemia. Rats were fed a standard diet or an obesity-promoting diet for 3 weeks, with or without treatment with COOH, a nonthiazolidinedione PPAR-gamma agonist.

Is the gender difference in LDL size explained by the metabolic complications of visceral obesity?

Background: Several studies have reported a significant gender difference in low-density lipoprotein (LDL) size, with men being characterized by smaller, denser LDL particles than women, and it has been suggested that the contribution of the greater accumulation of visceral adipose tissue in men compared with women may be a factor potentially contributing to the gender difference in LDL heterogeneity.

Materials And Methods: We measured LDL particle size by 2-16% nondenaturing polyacrylamide gradient gel electrophoresis in 299 men and 231 women in whom visceral adipose tissue accumulation was measured by computed tomography. A fasting plasma lipoprotein-lipid profile was also obtained in all subjects.

Role of specific cytochrome P450 enzymes in the N-oxidation of the antiarrhythmic agent mexiletine.

1. Mexiletine is extensively metabolized in man by C- and N-oxidation and the aim of the present study was to characterize major cytochrome P450 enzyme(s) involved in the formation of N-hydroxymexiletine. 2.

Mitral annulus velocities by Doppler tissue imaging: practical implications with regard to preload alterations, sample position, and normal values.

Because it appears to be less affected by changes in preload, mitral annulus Doppler tissue imaging (DTI) has been proposed as an alternate mean of identifying pseudonormal patterns of left ventricular filling. We thus studied the practical implications of DTI in 40 patients classified according to the Canadian Consensus on Diastolic Function (9 control participants, 9 with impaired relaxation, and 22 pseudonormal participants). Using DTI, the early diastolic velocity (Ea) was the most reproducible parameter whereas the late diastolic velocity (Aa) and Ea/Aa ratio varied significantly.

Does bone change after biliopancreatic diversion?

This prospective study evaluated bone changes after biliopancreatic diversion (BPD) consisting of a distal gastrectomy, a 250 cm alimentary channel, and a 50 cm common channel. Thirty-three consecutive patients had clinical, biochemical, and bone mineral density analysis before surgery and 4 and 10 years after surgery. Iliac crest bone biopsies and special tests including parathyroid hormone (PTH), 25-hydroxyvitamin D (25-OH-D), 1,25-dihydroxyvitamin D (1,25-OH(2)-D), bone-specific alkaline phosphatase (BAP), and osteocalcin were obtained at surgery and 4 years postoperatively.

Ethanol protects against lysophosphatidylcholine-induced uncoupling of cardiac cell pairs.

Moderate alcohol consumption is related to a reduction in cardiovascular deaths. Lysophosphatidylcholine (LPC) produces arrhythmias similar to those induced by ischemia most likely due to its uncoupling properties. We assessed effects of LPC in the presence of ethanol in cardiac myocyte pairs using the double whole-cell voltage-clamp technique.

A tryptophan residue (W736) in the amino-terminus of the P-segment of domain II is involved in pore formation in Na(v)1.4 voltage-gated sodium channels.

Voltage-gated Na channels comprise four homologous domains each consisting of six transmembrane segments (S1-S6) linked by loops. The linkers between segments S5 and S6 in each domain (P-loops), denoted as SS1-SS2, form the pore of the channel. It is believed that the SS1 region of the P-loops dips into, while the SS2 region exits out of the membrane.

Independent contribution of left ventricular ejection time to the mean gradient in aortic stenosis.

Background And Aims Of The Study: Transvalvular mean pressure gradients (MPG) are important in the evaluation of aortic stenosis, but surprisingly they often differ in patients having similar valve effective orifice area (EOA) and stroke volume (SV). The study aim was to determine if these differences could be explained by variations in left ventricular ejection time (LVET).

Methods: A pulse duplicator system with a constant SV of 75 ml and incremental increases of LVET from 250 to 450 ms was used to measure MPG by Doppler echocardiography in three fixed stenoses (0.