Showing papers by "Heart and Diabetes Center North Rhine-Westphalia published in 2008"

Dietary Advanced Glycation Endproducts and Oxidative Stress

Abstract: Advanced glycation endproducts (AGEs) and oxidative stress (OS) contribute to the development and progression of diabetic complications. We have reported that dietary AGEs and OS induce acute endothelial dysfunction in vivo, but little is known about their effects on adipokines. Twenty inpatients with type 2 diabetes mellitus (mean age: 55.9; range: 32-71 years), received a standard diabetes diet for 6 days. On days 4 and 6, the acute effects of a high-AGE (HAGE) or a low-AGE (LAGE) meal (15.100 vs. 2.750 kU AGE) were studied in a randomized, cross-over, investigator-blinded design. Measurements were performed after an overnight fast, at baseline (B) and at 2, 4, and 6 h after the HAGE or LAGE meals. Both meals had the same ingredients and differed only by the cooking method. Two h following HAGE, a significant decrease from baseline occurred in adiponectin (-10%*double dagger vs. +0%) and leptin (-22%*double dagger vs. -13%*), and a significant increase occurred in vascular cell adhesion molecule 1 (+19%*double dagger vs. -5%) and thiobarbituric acid reactive substances (+23%*double dagger vs. +6%). These changes did not occur, or occurred to a lesser extent, following LAGE. At 4 h following HAGE, an increase in methylglyoxal (+20%double dagger vs. -5%) and E-selectin (+54%*double dagger vs. -3%) occurred. Urinary AGEs increased only after HAGE (+51%*double dagger vs. -2%; values presented as HAGE vs. LAGE; *P < 0.05 vs. baseline, double daggerP < 0.05 vs. LAGE). The postprandial excursions in glucose, insulin, and triglycerides were similar between both meals. A meal rich in AGEs induces acute endothelial and adipocyte dysfunction. These effects were prevented by changing the cooking method.

Recommendations for the management of individuals with acquired valvular heart diseases who are involved in leisure-time physical activities or competitive sports:

Abstract: Physical check-ups among athletes with valvular heart disease are of significant relevance. In athletes with mitral valve stenosis the extent of allowed physical activity is dependant on the size of the left atrium and the severity of the valve defect. Patients with mild-to-moderate mitral valve regurgitation can participate in all types of sport associated with low and moderate isometric stress and moderate dynamic stress. Patients under anticoagulation should not participate in any type of contact sport. Asymptomatic athletes with mild aortic valve stenosis can take part in all types of sport, as long as left ventricular function and size are normal, a normal response to exercise at the level performed during athletic activities is present and there are no arrhythmias. Asymptomatic athletes with moderate aortic valve stenosis should only take part in sports with low dynamic and static stress. Aortic valve regurgitation is often present due to connective tissue disease of a bicuspid valve. Athletes with mild aortic valve regurgitation, with normal end diastolic left ventricular size and systolic function can participate in all types of sport. A mitral valve prolapse is often associated with structural diseases of the myocardium and endocardium. In patients with mitral valve prolapse Holter-ECG monitoring should also be performed to detect significant arrhythmias. All athletes with known valvular heart disease, a previous history of infective endocarditis and valve surgery should receive endocarditis prophylaxis before dental, oral, respiratory, intestinal and genitourinary procedures associated with bacteraemia. Sport activities have to be avoided during active infection with fever.

Risk Factor Analysis in Pediatric Heart Transplantation

Abstract: BACKGROUND: Steady assessment of risk factors will enable identification of patients at higher risk for post-transplant death, and may thus improve organ utilization and outcomes. In this study we ...

Complications of type 1 diabetes: new molecular findings.

Abstract: Interventions targeting the treatment of diabetic complications have not been nearly as successful as initially estimated, despite a marked improvement in therapeutic options for diabetes. The need for understanding why some very promising interventions have failed demands a closer look at the pathomechanisms of the complications. Great strides have been made in understanding the pathology, and several important hypotheses have emerged in recent years. On this basis, Brownlee and coworkers suggested a unifying hypothesis integrating various mechanisms discussed in past years with an overproduction of reactive oxygen species as an initiating cause. This hypothesis and further hypotheses, as well as mechanisms, are highlighted in this article. The field of pathomechanisms of diabetic complications is very wide, and any attempt to completely cover it within a single article is unrealistic. Therefore, our purpose is to present the most relevant concepts underlying diabetic complications in an attempt to contribute to a better understanding and pinpoint areas that warrant further research. Mt Sinai J Med 75:328–351, 2008. © 2008 Mount Sinai School of Medicine

Low night-to-night variability of sleep disordered breathing in patients with stable congestive heart failure.

Abstract: Sleep disordered breathing (SDB) has a high prevalence and prognostic impact in patients with chronic heart failure (CHF). Aim of this study was to investigate variability of SDB parameters in patients with stable CHF. Cardiorespiratory polygraphy was used to determine SDB in two consecutive nights in 50 CHF patients (NYHA class ≥ II, LV-EF ≤ 40%). The apnoea—hypopnoea—index (AHI) and apnoea—index (AI) were used to quantify SDB severity. Central, obstructive or mixed SDB were classified according to the majority of events. There was an excellent correlation in AHI (r = 0.948, P < 0.001) and AI (r = 0.842, P < 0.001) results of both nights. The overall number of detected apnoea and hypopnoea during the first night as compared to the maximum of both nights was 85% for the AHI and 77% for the AI. The reproducibility was dependent on SDB severity: AHI 15–29/h = 87%, AHI ≥ 30/h = 92% and AI ≥ 10/h = 83%. Classification was identical in 17 out of 19 patients with AI ≥ 10/h. In patients with stable CHF a single night of cardiorespiratory monitoring leads to representative results on severity and type of SDB. This may enhance the applicability and dissemination of cardiorespiratory polygraphy in clinical practice.

Cardiac retransplantation in adults: an evidence-based systematic review.

Abstract: Background It remains a matter of dispute whether cardiac retransplantation should be performed. We aimed to systematically review the available evidence regarding cardiac retransplantation in adults. Material and methods In PubMed, we searched for original reports on cardiac retransplantation in adults. The evidence level of individual studies was assessed. Results Twenty-two studies met our selection criteria. The cumulative incidence was 3% (range: 1% to 15%). The incidence rate was 164/10,000 person-years (range: 145 to 318/10,000 person-years). The main indications for retransplantation were cardiac allograft vasculopathy (55%), acute rejection (19%), and primary graft failure (17%). The early mortality rate was 16% (range: 5% to 38%). Refractory acute rejection and primary graft failure, female donor, shorter transplant interval, initial diagnosis of ischemic cardiomyopathy, need for mechanical circulatory support, a center volume of less than 9 transplantations/year, older recipient age, requirement of pretransplant ventilator and intensive care, and ischemic time were associated with poorer outcomes, while cardiac allograft vasculopathy as the cause of allograft failure, employment, and later transplant period were associated with improved survival. Conclusion This systematic review shows that the results of cardiac retransplantation in adults are inconclusive. Retransplantation for cardiac allograft vasculopathy is associated with satisfactory outcomes.

Unusual Complication With Transcatheter Closure of an Atrial Septal Defect Prevented by Adequate Imaging

Abstract: A 44-year-old woman with progressive dyspnea was referred for transcatheter closure of a recently diagnosed secundum atrial septal defect (ASD). Chest x-ray showed prominent pulmonary arteries, a mild pulmonary volume overload, and a moderate right ventricular enlargement (Figure 1). ECG demonstrated normal sinus rhythm with mild repolarization disturbances in leads III and avL, an incomplete right bundle-branch block, and an indifferent axis with normal time intervals (Figure 2). Cardiac catheterization revealed a significant left-to-right shunt (Qp:Qs=2.9) and coronary angiography a type RII …

Percutaneous septal ablation after unsuccessful surgical myectomy for patients with hypertrophic obstructive cardiomyopathy.

Abstract: To evaluate the long-term outcome of percutaneous septal ablation (PTSMA) after a previous myectomy. Myectomy usually results in symptomatic improvement and reduction of dynamic obstruction in hypertrophic obstructive cardiomyopathy patients (HOCM-pts.). However, a few pts. remain with severe symptoms and obstruction, and need additional interventions. We reviewed our database of 450 pts. who underwent PTSMA in our institution, and identified 11 (7 women, 4 men, mean age: 50 ± 14 years) with residual or recurrent NYHA class symptoms ≥III and significant left ventricular outflow obstruction (LVOTO) despite a previous myectomy 4 ± 5 years ago. In-hospital and follow-up data covering 6 ± 4 years, focusing on mortality and morbidity, symptoms, exercise capacity, and echocardiographic measures were collected. PTSMA was performed by injection of 3.6 ± 2.9 ml of alcohol. There was no peri-procedural or late death in this cohort. CK peaked at 614 ± 434 U/l. In addition to two pts. who already had a pacemaker implanted, two more (18%) who both had pre-existing left bundle branch block were pacemaker-dependent after PTSMA. During follow-up, 9 pts. (81%) reported significant and stable improvement. Two pts. (18%) developed progressive class III symptoms until their last follow-up, one of these together with persistent AF and a non-fatal stroke, the other received an ICD for primary prophylaxis and entered our pre-transplant program. Echo-Doppler showed sustained LVOTO elimination without global LV dilatation in all cases. PTSMA is an effective non-surgical option for treating symptoms and residual or recurrent LVOTO after a previous surgical myectomy. The high rate of conduction disturbances in this post-surgical cohort translated into a higher rate of pacemaker dependency after PTSMA.

Prolapsing left atrial myxoma: preoperative diagnosis using a multimodal imaging approach with magnetic resonance imaging and real-time three-dimensional echocardiography

Abstract: Real-time three-dimensional echocardiography (RT3DE) is a new promising technique for the evaluation of intracardiac masses. We present the diagnostic work-up using a multimodal-imaging approach in a 74-year-old patient with a prolapsing tumour in the left atrium suggestive of a myxoma, causing severe congestive heart failure attributable to dynamic left ventricular inflow obstruction, and mimicking severe mitral valve stenosis. Real-time three-dimensional echocardiography allowed to accurately image the entire volume of the myxoma, and to analyse the dynamic left ventricular inflow obstruction. The size of the lobulated mass as assessed by RT3DE was 65 × 25 × 22 mm. The mass was surgically removed, histology was diagnostic for myxoma, and the patient had an uneventful recovery. Real-time three-dimensional echocardiography images the entire volume of a mass allowing for accurate measurements in multiple planes, and allowing for real-time evaluation of obstructive effects on ventricular in- or outflow. This case shows how RT3DE and other non-invasive imaging modalities may be used as complementary techniques for evaluation of intracardiac masses.

Etiology of stroke after mechanical heart valve replacement--results from a ten-year prospective study.

Abstract: BACKGROUND AND AIMS OF THE STUDY In patients carrying mechanical valve prostheses it is assumed that cardioembolic strokes account for 70 - 90 % of clinically diagnosed thromboembolic complications. The etiology of stroke especially in older patients with mechanical heart valves may thus be multiple and not prosthetic valve-related in a substantial percentage. It was the aim of this prospective study to analyze the etiology of stroke in consecutive patients, who had mechanical heart valve replacement before. METHODS During a 10-year period, 89 consecutive patients were hospitalized at the authors' institution late (> 90 days) after mechanical valve replacement with definite stroke according to the WHO Monica criteria for stroke registers. RESULTS CCT or MRI revealed cerebral bleedings in 69 (77.5 %) patients, which were small in 42 (60.9 %), intermediate in 24 (34.8 %), and massive in three (4.3 %). Non-embolic, lacunary infarctions were documented in seven (8 %) and embolic strokes in 13 (17%) patients. According to the findings by CCT/ MRI and duplex sonography of the carotid arteries, stroke was considered atherothrombotic in seven of these 13 patients with embolic strokes (53.8 %). Six of these seven patients (86 %) had recurrent neurologic symptoms. In the other four, prosthesis-related stroke was most likely due to a yet undiagnosed active prosthetic valve endocarditis. In only two (2.3%) of the 89 stroke patients, was etiology probably prosthesis-related. Patients with an INR > 5.0 had ischemic stroke in three, and bleedings in four, patients with an INR < 1.8 ischemic strokes in one, and bleedings in three cases. CONCLUSIONS In conclusion, the vast majority of strokes after mechanical valve implantation in our cohort study were hemorrhagic rather than ischemic in origin, irrespective of the intensity of the oral anticoagulation. For proper treatment decisions, it is therefore essential to discriminate the underlying etiology of stroke.

Drugs for the treatment of diabetes complications. Zycose: a new player in the field?

Abstract: Zycose is a newly released (2006) combined medication containing folic acid (1 mg) benfotiamine (150 mg) and benzamine (850 mg), a proprietary blend of para-aminobenzoic acid (PABA), vitamin E and alpha-lipoic acid (ALA). Zycose protects vascular, retinal and kidney function by improving cellular health and promoting peripheral nerve health in people with diabetes. Zycose's therapeutic benefit is believed to be due to the additive effects of its compounds on lowering homocysteine levels (folic acid), reducing the production of advanced glycation end products (benfotiamine), improving endothelial function (folic acid, benfotiamine, ALA), reducing oxidative stress (ALA, vitamin E) and reducing carbonyl stress (benzamine). The complex composition of Zycose allows the therapeutic intervention of several hyperglycemiamediated disorders. The compound consists mainly of vitamins, therefore explaining, in part, the good safety profile and reduced adverse effects.

Echo-guided percutaneous coil embolization of a symptomatic massive metastasis of a renal cell carcinoma in the right ventricular outflow tract

Abstract: We present the case of a 41-year-old woman who was admitted to our centre with progressive symptoms of congestive heart failure (NYHA class III) 5 years after a radical nephrectomy for renal cell carcinoma. Magnetic resonance imaging demonstrated a 5 × 3 cm homogeneous intracardial mass causing right ventricular outflow tract obstruction, not accessible to surgical resection. Serial echo-guided, percutaneous coil embolization of the cardial metastasis was performed with Contour SE Microparticles® (150–250 or 300–500 μm) after identification of the target region of the metastasis by contrast injection (Levovist®) through the balloon catheter into the coronary artery under transoesophageal echocardiographic control prior to induction of the necrosis, corresponding to the technique which has been described for septal ablation in hypertrophic obstructive cardiomyopathy. Follow-up after serial embolization showed a good haemodynamic and a marked clinical response (dyspnoea NYHA I–II) which lasted during the 19 month of survival after the index procedure.

Uncommon intraventricular thrombus formation between the posterior mitral leaflet and the lateral left ventricular wall

Abstract: Transthoracic echocardiography demonstrated an intraventricular mass between the posterior mitral leaflet and the lateral left ventricular (LV) free wall in a 61-year-old man. Because of this uncommon localization an intracardial tumor, an endocarditis of the mitral valve or an intraventricular thrombus was suspected. Magnetic resonance imaging (MRI) ruled out an intracardial tumor and revealed a myocardial scarring of the LV free wall covered by an intraventricular thrombus by late gadolinium enhancement. MRI can distinguish subacute clots—which do not enhance after contrast material injection—from organized thrombi. The characterization of thrombi can be used to predict the risk of embolism, which is higher for subacute clots than for organized thrombi.

Major Polymer Damage of Drug-Eluting Stents

Abstract: A 67-year-old man presented with stable angina pectoris on exertion. He had a history of type 2 diabetes, severe peripheral vascular disease with bilateral above-knee amputations, renal insufficiency requiring dialysis, and arterial hypertension for more than 20 years. Coronary angiography revealed a long, calcified 90% bifurcation lesion of the left anterior …