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Heart Diseases (heart + diseases)
Kinds of Heart Diseases Selected AbstractsPerformance of an Autonomous Telemonitoring System in Children and Young Adults with Congenital Heart DiseasesPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 10 2008PETER ZARTNER M.D. Background:Integrated telemonitoring systems controlling circulatory and electrical parameters in adults with an implanted pacemaker have shown to be advantageous during follow-up of this patient group. In children and young adults with a congenital heart disease (CHD), these systems have to cope with a diversity of varying arrhythmias and a broad range of intrinsic cardiac parameters. Additional problems arise from the patients' growth and anatomic anomalies. Methods:Since 2005, eight young patients (age 4.1, 37 years, mean 15.5 years) with a CHD received a pacemaker or implantable cardioverter defibrillator with an autonomous telemonitoring system at our clinic. The mean follow-up time was 395 days (range 106,834 days, 8.7 patient years). Results:In seven of eight patients the system transmitted information, which led to beneficial modifications of the current antiarrhythmic therapy. In three patients the reported events were of a critical nature. One patient remained event-free for 192 days after implantation. During follow-up, 96% of the days were covered. The system also transferred additional information on the effectiveness of antiarrhythmic medication and the impact of physical activity. Conclusions:Young patients with an insufficient intrinsic heart rate or progressing arrhythmia, in addition to the conventional indications for pacemaker or defibrillator implantation, seem to profit to a high percentage from a telemetric surveillance system. The fully automated procedure of device interrogation and information transmission gives a daily overview on system function and specific arrhythmic events, especially in children who are unaware of any symptoms. [source] Temporary Disturbances of the QT Interval Precede the Onset of Ventricular Tachyarrhythmias in Patients with Structural Heart DiseasesPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 10 2002BJÖRN HENRIK DIEM DIEM, B.H. et al.: Temporary Disturbances of the QT Interval Precede the Onset of Ventricular Tach-yarrhythmias in Patients with Structural Heart Diseases. An increase in sinus rate prior to ventricular tachyarrhythmias has been demonstrated in previous studies. There is no clear data available concerning changes in ventricular de- and repolarization prior to ventricular tachyarrhythmias, especially in patients with structural heart disease. Therefore, the aim of this study was to analyze the QT and QTc interval (Bazett's formula immediately before the onset of ventricular tachyarrhythmias in stored electrograms of patients with ICDs. The study analyzed 228 spontaneous ventricular tachyarrhythmia episodes in 52 patients (mean age 64 ± 10 years, 49 men, 3 women) and compared them with 146 electrograms of baseline rhythm recorded during regular ICD follow-up. Mean ventricular cycle length (CL), QT interval, and QTc were measured before the onset of ventricular tachyarrhythmia and during baseline rhythm. Prior to ventricular tachyarrhythmias onset, CL was significantly shorter than during baseline rhythm (714 ± 139 vs 828 ± 149 ms, P < 0.0001). By contrast, the QT interval (430 ± 67 ms) and QTc interval (518 ± 67 ms) were significantly prolonged before the onset of ventricular tachyarrhythmias as compared to baseline rhythm (QT 406 ± 67 ms, QTc 450 ± 61 ms; P < 0.0001). CL, QT, and QTc changes were independent of concomitant treatment with antiarrhythmic drugs. Ventricular tachyarrhythmias are preceded by a significant prolongation of the QT and QTc intervals. This phenomenon may represent a greater than normal disparity of repolarization recovery times possibly facilitating the development of ventricular tachyarrhythmias. [source] Endomyocardial biopsy derived adherent proliferating cells,A potential cell source for cardiac tissue engineeringJOURNAL OF CELLULAR BIOCHEMISTRY, Issue 3 2010Marion Haag Abstract Heart diseases are a leading cause of morbidity and mortality. Cardiac stem cells (CSC) are considered as candidates for cardiac-directed cell therapies. However, clinical translation is hampered since their isolation and expansion is complex. We describe a population of human cardiac derived adherent proliferating (CAP) cells that can be reliably and efficiently isolated and expanded from endomyocardial biopsies (0.1,cm3). Growth kinetics revealed a mean cell doubling time of 49.9,h and a high number of 2.54,×,107 cells in passage 3. Microarray analysis directed at investigating the gene expression profile of human CAP cells demonstrated the absence of the hematopoietic cell markers CD34 and CD45, and of CD90, which is expressed on mesenchymal stem cells (MSC) and fibroblasts. These data were confirmed by flow cytometry analysis. CAP cells could not be differentiated into adipocytes, osteoblasts, chondrocytes, or myoblasts, demonstrating the absence of multilineage potential. Moreover, despite the expression of heart muscle markers like ,-sarcomeric actin and cardiac myosin, CAP cells cannot be differentiated into cardiomyocytes. Regarding functionality, CAP cells were especially positive for many genes involved in angiogenesis like angiopoietin-1, VEGF, KDR, and neuropilins. Globally, principal component and hierarchical clustering analysis and comparison with microarray data from many undifferentiated and differentiated reference cell types, revealed a unique identity of CAP cells. In conclusion, we have identified a unique cardiac tissue derived cell type that can be isolated and expanded from endomyocardial biopsies and which presents a potential cell source for cardiac repair. Results indicate that these cells rather support angiogenesis than cardiomyocyte differentiation. J. Cell. Biochem. 109: 564,575, 2010. © 2009 Wiley-Liss, Inc. [source] Experience With Implantable Loop Recorders for Recurrent Unexplained SyncopeCONGESTIVE HEART FAILURE, Issue 2008Michele Brignole MD Knowledge of what occurs during spontaneous syncope is the gold standard for evaluation. Initially, implantable loop recorders (ILRs) were used in patients with unexplained syncope at the end of unsuccessful full, conventional work-up. In pooled data regarding 247 patients, a correlation between syncope and electrocardiographic findings was found in 84 patients (34%); of these, 52% had a bradycardia or asystole at the time of the recorded event, 11% had tachycardia, and 37% had no arrhythmia. Presyncope-electrocardiography correlation was observed in another third of the patients; presyncope was much less likely to be associated with an arrhythmia than was syncope. The diagnostic yield was similar in patients with and without structural heart diseases and was higher in older than in younger patients. Recent studies showed that ILR implantation can be safely performed in an early phase of the diagnostic evaluation,provided that patients at risk for life-threatening events are carefully excluded,in the patients who have a severe presentation of syncope (because of high risk of trauma or high frequency of episodes) which can be a benefit of a mechanism-specific therapy. Congest Heart Fail. 2008;14:7,12. ©2008 Le Jacq [source] Aldose reductase gene is associated with diabetic macroangiopathy in Japanese Type 2 diabetic patientsDIABETIC MEDICINE, Issue 8 2006A. Watarai Abstract Aims The aldose reductase (AR) gene, a rate-limiting enzyme of the polyol pathway, has been investigated as a candidate gene in determining susceptibility to diabetic microangiopathy. However, the association of the AR gene with diabetic macroangiopathy has not been investigated. Therefore, the present study was conducted to determine whether genetic variations of AR may determine susceptibility to diabetic macroangiopathy. Methods There were 378 Type 2 diabetic patients enrolled in this study. A single nucleotide polymorphism in the promoter region (C-106T) was genotyped and the AR protein content of erythrocytes measured by ELISA. Results There were no significant differences in genotypic or allelic distribution in patients with or without ischaemic heart diseases, but there was a significant increase in the frequency of the CT + TT genotype and T allele in patients with stroke (P = 0.019 and P = 0.012). The erythrocyte AR protein content was increased in patients with the CT and TT genotype compared with those with the CC genotype. After adjustment for age, duration of diabetes, body mass index, systolic blood pressure, HbA1c, and serum creatinine, triglycerides, and total cholesterol in multivariate logistic-regression models, the association between this AR genotype and stroke remained significant. Conclusions Our results suggest that the CT or TT genotype of the AR gene might be a genetic marker of susceptibility to stroke in Type 2 diabetic patients. This observation might contribute to the development of strategies for the prevention of stroke in Type 2 diabetic patients. [source] Fibrosis in heart disease: understanding the role of transforming growth factor-,1 in cardiomyopathy, valvular disease and arrhythmiaIMMUNOLOGY, Issue 1 2006Razi Khan Summary The importance of fibrosis in organ pathology and dysfunction appears to be increasingly relevant to a variety of distinct diseases. In particular, a number of different cardiac pathologies seem to be caused by a common fibrotic process. Within the heart, this fibrosis is thought to be partially mediated by transforming growth factor-,1 (TGF-,1), a potent stimulator of collagen-producing cardiac fibroblasts. Previously, TGF-,1 had been implicated solely as a modulator of the myocardial remodelling seen after infarction. However, recent studies indicate that dilated, ischaemic and hypertrophic cardiomyopathies are all associated with raised levels of TGF-,1. In fact, the pathogenic effects of TGF-,1 have now been suggested to play a major role in valvular disease and arrhythmia, particularly atrial fibrillation. Thus far, medical therapy targeting TGF-,1 has shown promise in a multitude of heart diseases. These therapies provide great hope, not only for treatment of symptoms but also for prevention of cardiac pathology as well. As is stated in the introduction, most reviews have focused on the effects of cytokines in remodelling after myocardial infarction. This article attempts to underline the significance of TGF-,1 not only in the post-ischaemic setting, but also in dilated and hypertrophic cardiomyopathies, valvular diseases and arrhythmias (focusing on atrial fibrillation). It also aims to show that TGF-,1 is an appropriate target for therapy in a variety of cardiovascular diseases. [source] Genetic Polymorphism of KCNH2 Confers Predisposition of Acquired Atrial Fibrillation in ChineseJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 10 2009QUN-SHAN WANG M.D. Introduction: Nonfamiliar atrial fibrillation (AF) is usually associated with acquired structural heart disease, including valvular heart disease, coronary artery disease, and hypertension. Suggestive evidence indicates that these forms of acquired AF are more likely to occur in individuals with a genetic predisposition. We investigated the effect of the potassium channel voltage-gated subfamily member 2 (KCNH2) gene on the prevalence of acquired AF in a Chinese population. Methods: In a pair-matched, hospital-based case control study (297 vs 297) conducted in Chinese Hans, we investigated 4 tagging single nucleotide polymorphisms (tSNPs), rs1805120, rs1036145, rs3807375, and rs2968857 in the KCNH2 gene, and determined their association with AF acquired from structural heart diseases. Results: We did not observe the association of rs1036145, rs3807375, and rs2968857 with AF. However, we determined that the tSNP, rs1805120, in exon 6 confers the risk of AF in Chinese Hans. Both genotype and allele frequencies of rs1805120 were distributed differently in cases and controls (P = 0.0289 and P = 0.0172, respectively). The most significant association was observed under a recessive model for the minor GG genotype with a 1.45-fold risk of developing AF (95% confidence interval 1.09,1.93, P = 0.012). The significance remained after controlling for the covariates of age, smoking, BMI, hypertension, and diabetes. Conclusion: We report a new genetic variation (rs1805120) in the KCNH2 gene that predisposes Chinese Han individuals to the risk of acquired AF. Further genetic and functional studies are required to identify the etiological variants in linkage disequilibrium with this polymorphism. [source] Risk factors of Hong Kong Chinese patients with coronary heart diseaseJOURNAL OF CLINICAL NURSING, Issue 7 2007Sek Ying Chair RN Aims and objectives., The aims of the study were to describe the level of modifiable coronary risk factors and to explore the relationships among these risk factors in patients with coronary heart disease. Background., Appropriate patient education and therapies for coronary risk reduction will prevent recurrent cardiac events and progression of coronary heart disease. Therefore, having knowledge of the risk profile of these patients is essential so that appropriate contents and focus of patient educations can be developed. Methods., Coronary heart disease patients admitted for cardiac catheterization at the two studied hospitals in Hong Kong were recruited for this study. Demographic date and risk factors of blood pressure, smoking status, body mass index, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and exercise level were collected from subjects as well as from medical records for analysis. Results., The body mass index was significantly different among non-smoker, ex-smoker and smoker (p = 0·027). Non-smokers had the highest body mass index but smokers had the lowest body mass index among the three groups in this study. Physical inactivity, overweight and hypercholesterolaemia were the risk factors seen in about 50% of the studied subjects. Body mass index correlated positively with systolic blood pressure but negatively correlated with high-density lipoprotein cholesterol and hour of exercise. Conclusions., Heavier subjects had a higher systolic blood pressure but a lower level of high-density lipoprotein cholesterol. Heavier subjects also exercised less. The study results provided additional information on the database of the risk profile among Hong Kong cardiac patients. Relevance to clinical practice., Hypertension, obesity, physical inactivity, abnormal serum lipid levels and smoking are the modifiable risk factors for coronary heart diseases. As physical inactivity, overweight and hypercholesterolaemia were found in half of the studied subjects, the importance of risk factors control should be addressed to this group of patients. Nurses should be aware of their educator role to provide appropriate education to coronary heart disease patients with the focus on reducing and controlling of cardiac risk factors, which has been shown to be effective in reducing the progress of disease. [source] What cause of mortality can we predict by cholesterol screening in the Japanese general population?JOURNAL OF INTERNAL MEDICINE, Issue 2 2003T. Okamura Abstract., Okamura T, Kadowaki T, Hayakawa T, Kita Y, Okayama A, Ueshima H (Shiga University of Medical Science, Shiga, Japan; Iwate Medical University, Morioka, Iwate, Japan). What cause of mortality can we predict by cholesterol screening in the Japanese general population? J Intern Med 2003; 253: 169,180. Objective., In a population with a markedly lower coronary mortality such as in Japan, the benefit of cholesterol screening may be different from Western populations. We attempted to assess the importance of cholesterol screening in Japan. Design., A 13.2-year cohort study for cause-specific mortality. Setting., Three hundred randomly selected districts throughout Japan in which the National Survey on Circulatory Disorders 1980 was performed. Subjects., A total of 9216 community dwelling persons aged 30 years and over, with standardized serum cholesterol measurement and without a past history of cardiovascular disease. Results., There were 1206 deaths, which included 462 deaths due to cardiovascular disease with 79 coronary heart diseases. Hypercholesterolemia (>6.21 mmol L,1) showed a significant positive relation to coronary mortality (relative risk; 2.93, 95% confidence interval; 1.52,5.63) but not to stroke. Although hypocholesterolemia (<4.14 mmol L,1) was significantly associated with an increased risk of liver cancer, noncardiovascular, noncancer disease and all-cause mortality, these associations, except for liver cancer, disappeared after excluding deaths in the first 5 years of the follow-up. The multivariate adjusted attributable risk of hypercholesterolaemia for coronary disease was 0.98 per 1000 person-years, which was threefold higher than that of hypocholesterolemia for liver cancer: 0.32 per 1000 person-years. The attributable risk percentage of hypercholesterolaemia was 66% for coronary heart disease. Conclusion., Similar to Western populations, it is recommended to provide screening for hypercholesterolaemia in Japan, especially for males, although its attributable risk for coronary disease might be small. [source] New Technique for Fenestration of the Interatrial SeptumJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2006MUTHUKUMARAN SIVAPRAKASAM M.R.C.P.C.H. Achieving controlled flow between the systemic and pulmonary venous circulations is desirable in many complex congenital heart diseases. This includes the Fontan circulation, primary pulmonary hypertension, double inlet ventricles, or hypoplastic left heart with obstruction to the atrioventricular valve. As no specific device is available for this purpose, we developed a balloon-mounted stent technique to achieve a predetermined-sized fenestration of an atrial baffle in a patient with Fontan circulation. The details of the technique are described. [source] Alcohol Consumption, Social Support, and Risk of Stroke and Coronary Heart Disease Among Japanese Men: The JPHC StudyALCOHOLISM, Issue 6 2009Satoyo Ikehara Background:, It is unclear whether the association between alcohol consumption and risk of cardiovascular disease is affected by social support. Methods:, The prospective data for 19,356 men aged 40 to 69 years who participated in the Japan Public Health Center-Based Prospective Study. Alcohol consumption was classified into 7 categories: never, past, occasional, 1 to 149, 150 to 299, 300 to 449, or ,450 g ethanol/wk. Associations between alcohol consumption and risk of cardiovascular disease were stratified by the median level of social support score, which was measured in emotional support score of this cohort study. Results:, During an average follow-up of 9.9 years, 629 total strokes and 207 coronary heart diseases were documented. Light-to-moderate alcohol consumption was associated with reduced risks of coronary heart disease and total cardiovascular disease, while heavy alcohol consumption was associated with increased risk of total stroke, in particular hemorrhagic stroke. When stratified by social support score, the multivariable hazard ratios of total cardiovascular disease associated with light-to-moderate alcohol consumption (1 to 299 g/wk) were 0.99 (0.72 to 1.37) in the low social support group and 0.56 (0.44 to 0.70) in the high social support group (p for interaction = 0.002), while the multivariable hazard ratios of hemorrhagic stroke associated with heavy alcohol consumption (,300 g/wk) were 2.09 (1.03 to 4.27) in the low social support group and 1.25 (0.72 to 2.15) in the high social support group (p for interaction = 0.44). There was no interaction between alcohol consumption and social support in relation to risk of coronary heart disease. Conclusions:, Social support may enhance the beneficial effect of light-to-moderate alcohol consumption on risk of cardiovascular disease. [source] Mixture cure survival models with dependent censoringJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES B (STATISTICAL METHODOLOGY), Issue 3 2007Yi Li Summary., The paper is motivated by cure detection among the prostate cancer patients in the National Institutes of Health surveillance epidemiology and end results programme, wherein the main end point (e.g. deaths from prostate cancer) and the censoring causes (e.g. deaths from heart diseases) may be dependent. Although many researchers have studied the mixture survival model to analyse survival data with non-negligible cure fractions, none has studied the mixture cure model in the presence of dependent censoring. To account for such dependence, we propose a more general cure model that allows for dependent censoring. We derive the cure models from the perspective of competing risks and model the dependence between the censoring time and the survival time by using a class of Archimedean copula models. Within this framework, we consider the parameter estimation, the cure detection and the two-sample comparison of latency distributions in the presence of dependent censoring when a proportion of patients is deemed cured. Large sample results by using martingale theory are obtained. We examine the finite sample performance of the proposed methods via simulation and apply them to analyse the surveillance epidemiology and end results prostate cancer data. [source] Increased Ventricular Ectopic Activity in Relation to C-Reactive Protein, and NT-Pro-Brain Natriuretic Peptide in Subjects With No Apparent Heart DiseasePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2006AHMAD SAJADIEH M.D. Background: Subjects with frequent ventricular premature complexes (VPC) and no apparent heart disease make a heterogenic group with regard to prognosis. Some biomarkers have recently proved useful in risk stratification in different heart diseases. We examined prognostic impact of NT-Pro-brain natriuretic peptide (NT-Pro BNP), and C-reactive protein (CRP) in relation to frequent VPC in subjects with no apparent heart disease. Methods: Six hundred seventy-eight healthy subjects between 55 and 75 years of age with no history of cardiovascular disease were included in the study. All were tested with fasting laboratory testing and 48-hour ambulatory ECG monitoring. Frequent VPC was defined as VPC ,30/hour. Results: In 56 subjects (8%) with frequent VPC the prognosis was much poorer compared to those without frequent VPC (Hazard ratio and 95% CI: 2.3;1.2,4.4, P = 0.01), after adjustment for conventional risk factors. In subjects with frequent VPC increased levels of CRP (above 2.5 ,g/mL) was the only factor among the tested biomarkers, which was associated with a poor prognosis. Taking subjects without frequent VPC as reference, the hazard ratio and 95% CI for subjects with frequent VPC and increased CRP was 3.6;1.8,7.1, P = 0.0004, and for those with frequent VPC and normal CRP 0.8;0.2,3.5, P = 0.83, after correction for conventional risk factors. Conclusions: Among middle-aged and elderly subjects with no apparent heart disease and frequent VPCs, a CRP value ,2.5 ,g/mL is associated with a significantly higher risk of death and acute myocardial infarction. These subjects deserve primary prevention measures and further work up for structural heart disease. [source] Flexible fiberoptic bronchoscopy in children with heart diseases: A twelve years experiencePEDIATRIC PULMONOLOGY, Issue 4 2007Jaime Cerda MD Abstract In children, cardiac diseases and respiratory disorders are tightly linked entities whose evaluation should be performed integrally. Flexible fiberoptic bronchoscopy (FB) presents a diagnostic and therapeutic role by assessing the airway anatomically, dynamically, and through the performance of several procedures. The present study describes our experience on FB assessment in children with congenital and acquired cardiac diseases, providing a characterization of the principal demographic and clinical features. Records of 72 patients under 14 years (mean age 21 months) with heart diseases, corresponding to 104 FB performed between January 1993 and October 2004 were reviewed. The principal cardiac diseases were left-to-right shunt (51.9%), followed by right-to-left shunt (17.3%) and miscellaneous cardiopathies (8.7%). The main indications for FB assessment were study of atelectasis (35%), stridor (14%), and pneumonia (14%). Airway malacias, as a group, were the commonest finding, represented mainly by left main bronchus malacia (24%). The second most common finding was stenosis by extrinsic compression, and among these, 75% corresponded to left main bronchus compression. Sixteen different types of clinically meaningful utilities were obtained. No mortality was reported and in only one procedure was there a major complication, which was easily managed. We concluded that FB is an important and safe diagnostic,therapeutic tool in the health care of neonates, infants, and children with a variety of cardiac diseases. Pediatr Pulmonol. 2007; 42:319,324. © 2007 Wiley-Liss, Inc. [source] Evaluation of prenatal diagnosis of associated congenital heart diseases by fetal ultrasonographic examination in EuropePRENATAL DIAGNOSIS, Issue 4 2001C. Stoll Abstract Ultrasound scans in the mid trimester of pregnancy are now a routine part of antenatal care in most European countries. With the assistance of Registries of Congenital Anomalies a study was undertaken in Europe. The objective of the study was to evaluate prenatal detection of congenital heart defects (CHD) by routine ultrasonographic examination of the fetus. All congenital malformations suspected prenatally and all congenital malformations, including chromosome anomalies, confirmed at birth were identified from the Congenital Malformation Registers, including 20 registers from the following European countries: Austria, Croatia, Denmark, France, Germany, Italy, Lithuania, Spain, Switzerland, The Netherlands, UK and Ukrainia. These registries follow the same methodology. The study period was 1996,1998, 709,030 births were covered, and 8126 cases with congenital malformations were registered. If more than one cardiac malformation was present the case was coded as complex cardiac malformation. CHD were subdivided into ,isolated' when only a cardiac malformation was present and ,associated' when at least one other major extra cardiac malformation was present. The associated CHD were subdivided into chromosomal, syndromic non-chromosomal and multiple. The study comprised 761 associated CHD including 282 cases with multiple malformations, 375 cases with chromosomal anomalies and 104 cases with non-chromosomal syndromes. The proportion of prenatal diagnosis of associated CHD varied in relation to the ultrasound screening policies from 17.9% in countries without routine screening (The Netherlands and Denmark) to 46.0% in countries with only one routine fetal scan and 55.6% in countries with two or three routine fetal scans. The prenatal detection rate of chromosomal anomalies was 40.3% (151/375 cases). This rate for recognized syndromes and multiply malformed with CHD was 51.9% (54/104 cases) and 48.6% (137/282 cases), respectively; 150/229 Down syndrome (65.8%) were livebirths. Concerning the syndromic cases, the detection rate of deletion 22q11, situs anomalies and VATER association was 44.4%, 64.7% and 46.6%, respectively. In conclusion, the present study shows large regional variations in the prenatal detection rate of CHD with the highest rates in European regions with three screening scans. Prenatal diagnosis of CHD is significantly higher if associated malformations are present. Cardiac defects affecting the size of the ventricles have the highest detection rate. Mean gestational age at discovery was 20,24 weeks for the majority of associated cardiac defects. Copyright © 2001 John Wiley & Sons, Ltd. [source] Circadian Distribution of Paroxysmal Atrial Fibrillation in Patients with and without Structural Heart Disease in Untreated StateANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 3 2009Yoshiaki Deguchi M.D. Background: This study aimed to compare the circadian distribution of the onset, maintenance and termination of paroxysmal atrial fibrillation (PAF) between structural and non-structural heart diseases (SHD and NSHD, respectively) in the untreated state. Subjects and Methods: We included 217 patients with 338 PAF (79 SHD patients with 131 episodes; 138 NSHD patients with 207 episodes). The probabilities for the onset, maintenance and termination of PAF for each hour were analyzed using Holter monitoring data and harmonic models being fitted into a cosinusoidal function. Results: The SHD group had a triphasic circadian pattern at the onset with higher peaks at midnight, in the early morning and in the late afternoon (p < 0.05), whereas the NSHD group showed a single peak at midnight (p < 0.01). The probability of maintenance revealed a single peak during midnight (SHD, p < 0.0001; NHD, p < 0.01). The termination showed a peak at noon in the SHD group (p < 0.05), whereas there was a double peak at 10:00 am and 8:00 pm in the NSHD group (p = 0.06). RR intervals just after the PAF onset showed marked shortening in the daytime initiation PAF as compared to the nighttime initiation PAF in both SHD and NSHD groups (p < 0.01). Conclusion: These observations suggest that the SHD group has very complex onset hours, whereas the NSHD group shows complex termination hours. Reflexly accelerated sympathetic tone just after the PAF onset is suggested in the daytime initiation PAF. [source] Relationship Between Myocardial Beta-Adrenergic Sensitivity and Heart Rate VariabilityANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2000Philippe Cabrol M.D. Background: In congestive heart failure, despite activation of the sympathetic nervous system, heart rate variability parameters reflecting sympathetic modulation on sinus node are decreased. Our goal was to assess the role of beta-adrenergic sensitivity in the modulation of heart rate variability (HRV) in patients with valvular heart diseases. Methods and results: Ten patients with aortic stenosis, 10 patients with heart failure, and 12 controls were included. Baroreflex sensitivity was calculated by the sequency method. Noradrenaline plasma levels were assayed by HPLC. HRV was studied using 24-hour Holter monitoring. Cardiac beta-adrenergic receptivity was assessed by the chronotropic response to dobutamine. Right auricular samples were obtained for determination of beta-adrenergic receptor density by binding study with [125I]-iodocynaopindolol, and beta 1 and beta 2 densities, measured by competition between 125ICP binding by isoprenaline. In multivariate analysis, the dose of dobutamine that increases basal heart rate for 25 beats/min (ED25) is correlated with a parameter of global HRV: SDNN (r = 0.6, P < 0.001) and with indexes reflecting rather sympathetic modulation of HRV: SDANN (r = 0.62, P < 0.001) or SD (r = 0.47, P < 0.0001). All these relations were independent from mean NN, spontaneous baroreflex sensitivity, and noradrenaline plasma levels. No significant correlation existed between dobutamine ED25 and HRV indexes reflecting parasympathic tone. No relationship existed between HRV and beta-adrenergic receptor-binding characteristics. Conclusion: Cardiac beta-adrenergic sensitivity explored by dobutamine ED25 is an important determinant of HRV independent from mean NN, spontaneous baroreflex sensitivity, and noradrenaline plasma levels. [source] Aging Adversely Impacts Biological Properties of Human Bone Marrow-derived Mesenchymal Stem Cells: Implications for Tissue Engineering Heart Valve ConstructionARTIFICIAL ORGANS, Issue 3 2010Yuan Xin Abstract Our aim was to study the aging effects on the in vitro biological properties of bone marrow-derived mesenchymal stem cells (BMSCs) for construction of tissue-engineered heart valves. BMSCs were taken from teenagers with congenital heart diseases, and middle-aged and elderly patients with valvular diseases. Proliferative abilities were compared among the three groups by using colony-forming unit counting and growth curves (5-bromo-2,-deoxyuridine assay). Cell differentiation, vascular endothelial growth factor (VEGF) release under hypoxic condition, and migratory abilities were compared as well. Colony-forming units in the teenage group were significantly greater than those in the other two groups (P < 0.05), and significantly higher counts were observed in the middle age group than in the aged group (P < 0.05). Growth curves presented similar trends in which cells' proliferative abilities in the aged group decreased significantly (P < 0.05), while no differences were noted between the two nonaged groups. The differentiation potential to endothelial cells, osteoblasts and adipocytes, VEGF releases, and migratory abilities differed significantly between the aged group and nonaged groups (P < 0.05). However, no differences were noted between the two nonaged groups. BMSCs from older patients with heart valve diseases could be harvested and expanded successfully, and the phenotype and morphology were uniform as nonaged groups. However, the proliferative and differentiation properties of aged cells, as well as cytokine release and migratory abilities, are significantly impaired. [source] Identification of mouse heart transcriptomic network sensitive to various heart diseasesBIOTECHNOLOGY JOURNAL, Issue 5 2008Seong-Eui Hong Abstract Exploring biological systems from highly complex datasets is an important task for systems biology. The present study examined co-expression dynamics of mouse heart transcriptome by spectral graph clustering (SGC) to identify a heart transcriptomic network. SGC of microarray data produced 17 classified biological conditions (called condition spectrum, CS) and co-expression patterns by generating bi-clusters. The results showed dynamic co-expression patterns with a modular structure enriched in heart-related CS (CS-1 and -13) containing abundant heart-related microarray data. Consequently, a mouse heart transcriptomic network was constructed by clique analysis from the gene clusters exclusively present in the heart-related CS; 31 cliques were used for constructing the network. The participating genes in the network were closely associated with important cardiac functions (e. g., development, lipid and glycogen metabolisms). Online Mendelian Inheritance in Man (OMIM) database indicates that mutations of the genes in the network induced serious heart diseases. Many of the tested genes in the network showed significantly altered gene expression in an animal model of hypertrophy. The results suggest that the present approach is critical for constructing a heart-related transcriptomic network and for deducing important genes involved in the pathogenesis of various heart diseases. [source] Preterm delivery and risk of subsequent cardiovascular morbidity and type-II diabetes in the motherBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2010JA Lykke Please cite this paper as: Lykke J, Paidas M, Damm P, Triche E, Kuczynski E, Langhoff-Roos J. Preterm delivery and risk of subsequent cardiovascular morbidity and type-II diabetes in the mother. BJOG 2010;117:274,281. Objective, Preterm delivery has been shown to be associated with subsequent maternal cardiovascular morbidity. However, the impact of the severity and recurrence of preterm delivery on the risk of specific cardiovascular events and the metabolic syndrome in the mother, have not been investigated. Design, National registry-based retrospective cohort study. Setting, Women delivering in Denmark from 1978 to 2007. Population, Women with a first singleton delivery (n = 782 287), and with a first and second singleton delivery (n = 536 419). Methods, Cox proportional hazard models, with the gestational age stratified into four groups as primary exposure. We made adjustments for maternal age, year of delivery, hypertensive pregnancy disorders, fetal growth deviation, placental abruption and stillbirth. Main outcome measures, Subsequent maternal hypertension, ischaemic heart diseases, thromboembolism and type-II diabetes. Results, After a first delivery at 32,36 completed weeks of gestation, the adjusted risk of subsequent type-II diabetes increased 1.89-fold (1.69,2.10) and the risk of thromboembolism increased 1.42-fold (1.24,1.62). Women having a preterm delivery in the first pregnancy and a term delivery in the second had a 1.58-fold (1.34,1.86) increased risk of type-II diabetes and a 1.18-fold (0.96,1.44) increased risk of thromboembolism. Women having two preterm deliveries had a 2.30-fold (1.71,3.10) increased risk of type-II diabetes and a 1.80-fold (1.29,2.50) increased risk of thromboembolism. Conclusions, Preterm delivery is independent of other pregnancy complications associated with subsequent maternal overt type-II diabetes and thromboembolism. The recurrence of preterm delivery will augment these risks. [source] Consumer Response to Information about a Functional Food Product: Apples Enriched with AntioxidantsCANADIAN JOURNAL OF AGRICULTURAL ECONOMICS, Issue 3 2009Armenak Markosyan Interest in functional foods has been growing as consumers become increasingly concerned with diet and nutrition. This article measures consumers' responses to apples enriched with an antioxidant coating. Antioxidant-enriched apples are believed to provide additional health benefits reducing the risk of cancer and heart diseases. We discuss the consumer's benefit-risk trade-offs. Although functional food products provide health benefits beyond basic nutrition, some consumers may reject them because they utilize new technology. Face-to-face consumer surveys with contingent valuation questions were conducted in Seattle and Spokane, Washington in 2006. Consumers who choose where to shop based on organic availability are less likely to pay a premium for apples enriched with antioxidants. Also, there is evidence that consumers in Spokane are more likely to pay a premium for the product than consumers in supermarkets in Seattle. Information regarding the potential health benefits of antioxidants has a positive significant effect on consumers' willingness to pay (WTP). The estimated mean WTP suggests that there is a small premium associated with this product in the mind of an average consumer. L'intérêt pour les aliments fonctionnels ne cesse de croître étant donné que les consommateurs s'intéressent de plus en plus au régime alimentaire et à la nutrition. Le présent article évalue la réaction des consommateurs à la vente de pommes enrobées d'antioxydants. On croit que les pommes enrichies d'antioxydants procureraient des bienfaits supplémentaires pour la santé en diminuant le risque de cancer et de cardiopathies. Nous avons examiné les avantages et les risques pour le consommateur. Bien que les aliments fonctionnels apportent des bienfaits pour la santé en plus d'une nutrition de base, certains consommateurs peuvent les refuser parce qu'ils ont nécessité l'utilisation de nouvelles technologies. En 2006, nous avons effectué, à Seattle et à Spokane dans l'État de Washington, des sondages en personne à l'aide de l'approche des préférences exprimées. Les consommateurs qui choisissaient un magasin d'alimentation en fonction de la disponibilité de produits biologiques étaient moins enclins à payer une prime pour obtenir des pommes enrichies d'antioxydants. Les consommateurs de Spokane ont semblé plus enclins à payer une prime pour ce produit que les consommateurs qui fréquentaient les supermarchés de Seattle. L'information sur les bienfaits potentiels des antioxydants sur la santé a des répercussions positives considérables sur la volonté de payer des consommateurs. La volonté de payer moyenne estimative laisse supposer que, dans l'esprit du consommateur moyen, ce produit procure un certain avantage. [source] Brain abscess in children , epidemiology, predisposing factors and management in the modern medicine eraACTA PAEDIATRICA, Issue 8 2010Y Shachor-Meyouhas Abstract Aims:, Brain abscess is rare in children. Predisposing factors are found in almost 85% of cases. Overall, 25% of brain abscesses develop in children, mostly in the 4,7 years age group. Our study aimed to characterize children with brain abscesses treated in our hospital, identify risk factors, pathogens and short-term outcome. Methods:, A retrospective cohort of 20 years period, (1989,2009) included 27children (0,18 years). Medical records were analysed for age, gender, presenting symptoms and signs, predisposing factors, laboratory tests, imaging, microbiology results, treatment and outcome. Results:, Of all the children, 63% (17/27) were male patients; mean age was 7.9 years and 52% were referred from other hospitals. Predisposing factors were identified in 81%, congenital heart disease and otitis were rare and sinusitis was found in 22% of the children. Main symptoms and signs included headaches, fever, neurological signs convulsions, (41%, 81%, 78% and 41% respectively). In 30% of cases, cultures were sterile. All patients were operated in addition to antibiotic treatment. Outcome was good with low mortality rate (3.7%). Conclusions:, Manifestations of brain abscess may be subtle. A high index of suspicion and early imaging are warranted, different predisposing factors may reflect early intervention for congenital heart diseases. Mortality is rare in the modern medicine era. [source] C,Reactive Protein and Atrial Fibrillation in Idiopathic Dilated CardiomyopathyCLINICAL CARDIOLOGY, Issue 9 2009Shimo MD Background Previous studies have found elevated plasma C-reactive protein (CRP) levels in atrial fibrillation (AF) patients. Most of these studies included AF patients with various heart diseases, but few studies were designed to investigate CRP in idiopathic dilated cardiomyopathy (IDCM) patients with AF. Method and Results CRP levels in 242 IDCM patients with AF were compared with CRP levels in 280 control IDCM patients. Among control patients, 70 had atrial premature beats or atrial tachycardia and 210 had normal sinus rhythm. CRP was higher in the AF group than in the control group (median, 4.59 versus 2.81 mg/L; p < 0.001). The prevalence of AF in IDCM patients increased as plasma CRP levels increased, and the patients with the highest plasma CRP levels had the highest probability of suffering from AF. Outcome of multivariate logistic regression analysis showed body mass index, AF, and white blood cell count significantly correlated with the plasma CRP levels. Conclusion Our data demonstrated that the plasma CRP level in IDCM patients with AF was higher than in IDCM patients without AF, and an increase in plasma CRP levels was associated with an increased prevalence of AF in IDCM patients. Also, body mass index, AF, and white blood cell count correlate with plasma CRP levels in IDCM patients. These data suggest there is presence of inflammation in IDCM patients with AF. Copyright © 2009 Wiley Periodicals, Inc. [source] Significance of Vectorcardiogram in the Cardiological Diagnosis of the 21st CenturyCLINICAL CARDIOLOGY, Issue 7 2007Andrés Ricardo Pérez Riera M.D Abstract Until the mid-1980s, it was believed that the vectorcardiogram presented a greater specificity, sensitivity and accuracy in comparison to the conventional electrocardiogram, in the diagnosis of the different heart diseases. Recent studies revealed that the vectorcardiogram still is superior to the electrocardiogram in very specific situations, such as in the evaluation of electrically inactive areas, in intraventricular conduction disorders combined and/or in association to inactive areas, in the identification and location of ventricular preexcitation, in the differential diagnosis of patterns varying from normal of electrical axis deviation, in the evaluation of particular aspects of Brugada syndrome, and in the estimation of the severity of some enlargements, among others. With the advent of computerized vectorcardiography, a technology that improves the processing and recording method; a future still promising is expected for this methodology. In the fields of education and research, vectorcardiography provided a better and more rational insight into the electrical phenomena that occurs spatially, and represented an important impact on the progress of electrocardiography. Although a few medical centers still use the method as a routine, we hope that the use of this resource will not get lost over time, since vectorcardiography still represents a source to enrich science by enabling a better morphological interpretation of the electrical phenomena of the heart. Copyright © 2007 Wiley Periodicals, Inc. [source] | ||||||||||||||||