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PubMed1991

Renal manifestations of NaCl sensitivity in borderline hypertensive rats.

Compared with the normotensive Wistar-Kyoto rat, the spontaneously hypertensive rat exhibits exaggerated alterations in renal sympathetic nerve activity and excretory function during volume expansion (exaggerated natriuresis) and environmental stress (antinatriuresis). The borderline hypertensive rat is the first filial offspring of the spontaneously hypertensive rat and the Wistar-Kyoto rat and develops hypertension with increased dietary NaCl intake. The present investigation sought to determine whether the dietary NaCl intake-induced transition from the normotensive state of the Wistar-Kyoto parent to the hypertensive state of the spontaneously hypertensive parent in the borderline hypertensive rat was accompanied by a similar transition of the renal sympathetic nerve activity and excretory responses to volume expansion and environmental stress. Borderline hypertensive rats fed a 1% NaCl diet remained normotensive and exhibited renal sympathetic nerve activity and excretory responses to volume expansion and environmental stress that were similar to those of their Wistar-Kyoto parent. Borderline hypertensive rats fed an 8% NaCl diet developed hypertension and exhibited responses that were similar to those of their spontaneously hypertensive parent. Thus, the dietary NaCl intake-induced transition from the normotensive state of the Wistar-Kyoto parent to the hypertensive state of the spontaneously hypertensive parent in the borderline hypertensive rat was accompanied by a similar transition of the renal sympathetic nerve activity and excretory responses to volume expansion and environmental stress. The results suggest that increased dietary NaCl intake is able to induce or unmask the capabilities for these responses, which are genetically conveyed to the borderline hypertensive rat by the spontaneously hypertensive rat parent in latent forms.

Animals↗
PubMed1991

Role of anteroventral third ventricle and vasopressin in renal response to stress in borderline hypertensive rats.

The borderline hypertensive rat is the first filial offspring of the spontaneously hypertensive rat and the Wistar-Kyoto rat. In response to acute environmental stress (air jet), the borderline hypertensive rat exhibits a diuretic response, whereas the parental strains exhibit an antidiuretic response (spontaneously hypertensive rat) or no change in urine flow rate (Wistar-Kyoto rat). This study sought to investigate the role of the periventricular tissue surrounding the anteroventral third ventricle and vasopressin release in the diuretic response of the borderline hypertensive rat to acute environmental stress. Sixteen-week-old borderline hypertensive rats who had consumed a 1% NaCl diet for 10-12 weeks were given either electrolytic lesions of the anteroventral portion of the third ventricle or sham lesions. When exposed to acute environmental stress 4 weeks later, the increase in volume of dilute urine seen in the sham-lesion rats was not observed in the lesion rats. Plasma vasopressin concentration was decreased by acute environmental stress in the sham-lesion rats (15.2 +/- 4.0 to 10.9 +/- 1.7 pg/ml, p less than 0.05) but was unchanged in the lesion rats (12.3 +/- 2.0 to 13.4 +/- 4.0 pg/ml). In a separate group of intact borderline hypertensive rats, a constant intravenous infusion of vasopressin prevented the diuretic response to acute environmental stress. The results suggest that acute environmental stress produces a diuresis in the borderline hypertensive rats via a decrease in plasma vasopressin concentration that is dependent on the integrity of the periventricular tissue of the anteroventral portion of the third ventricle.

Animals↗
PubMed1991

Dopaminergic abnormalities in borderline essential hypertensive patients.

To explore whether an altered metabolic pathway of dihydroxyphenylalanine (DOPA) may be related to some previously observed dopamine abnormalities in borderline hypertension, we measured basal and DOPA-induced (500 mg orally) changes in blood pressure and pulse rate as well as in three hourly plasma and urine samples. We found that borderline hypertensive patients compared with controls 1) showed a higher baseline urinary excretion of methoxytyramine, a marker of exocytotic dopamine release, with a greater DOPA-induced decrease of systolic blood pressure without reflex tachycardia; 2) had in response to DOPA a blunted plasma DOPA and free dopamine increase but an accentuated plasma dopamine sulfate and urinary DOPAC excretion; and 3) eliminated comparable quantities of dopamine in urine despite a lower rise in the glomerular DOPA load. Furthermore, although DOPA elicited natriuresis in both groups, its effect was greater in borderline hypertensive patients, who lacked the urinary sodium correlation with urinary dopamine excretion seen in control subjects. These data are compatible with increased basal exocytotic dopamine release and accelerated neuronal and renal (extraneuronal) dopamine generation from administered DOPA in borderline hypertension. The DOPA-induced hypernatriuresis exceeding augmented dopamine in borderline hypertensive patients, contrasting with the urinary sodium and dopamine correlation in control subjects, suggests that DOPA induced an additional natriuresis in borderline hypertensive patients by a decrease in renal sympathetic tone because of its central inhibition of sympathetic outflow, which also may account for the absence of reflex tachycardia.

Adult↗
PubMed1996

Stress-induced laboratory blood pressure in relation to ambulatory blood pressure and left ventricular mass among borderline hypertensive and normotensive individuals.

Our primary aim in the present study was to investigate the association between blood pressure measured in the laboratory and in the ambulatory state in a group of middle-aged borderline hypertensive men and age-matched normotensive control subjects. In addition, we examined the relation between stress-induced blood pressure measurements and left ventricular mass. Blood pressure and heart rate were measured noninvasively during a standardized laboratory stress protocol and four times per hour throughout 24 hours. Borderline hypertensive subjects had significantly higher systolic and diastolic pressures than normotensive subjects during both the daytime (systolic pressure, 141.1 +/- 9.7 versus 130.9 +/- 8.6 mm Hg; diastolic pressure, 88.8 +/- 7.0 versus 79.4 +/- 6.2 mm Hg, P < .001) and nighttime (systolic pressure, 114.0 +/- 9.9 versus 107.1 +/- 8.3 mm Hg; diastolic pressure, 71.5 +/- 7.5 versus 64.6 +/- 7.2 mm Hg, P < .001). The borderline hypertensive group also displayed increased systolic pressure reactivity in the laboratory compared with the normotensive group. The groups did not differ significantly in left ventricular mass (index). In both borderline hypertensive and normotensive individuals, blood pressure levels during stress testing were closely related to ambulatory blood pressure levels (r = .51 to .82). Furthermore, stress-induced blood pressure levels were significantly correlated to left ventricular mass in borderline hypertensive (r = .33 to .40) but not normotensive subjects. Since stress-induced blood pressure levels were significantly associated with both ambulatory blood pressure levels and left ventricular mass in borderline hypertensive subjects, the addition of standardized stress testing to casual blood pressure measurements may improve risk estimation.

Adult↗
PubMed1997

Association of serum antibodies to heat-shock protein 65 with borderline hypertension.

Heat-shock proteins protect cells from damage but are also often the target of immune responses in inflammation and may therefore both induce and perpetuate the chronic inflammation characterizing atherosclerosis. Hypertension is a well-established risk factor for atherosclerosis, and recently, borderline hypertension also has been related to atherosclerosis. The present study investigated the possible role of heat-shock proteins in borderline hypertension and their relation to atherosclerosis by investigating antibody titers against the 65-kD heat-shock protein (HSP65). Sixty-six men with borderline hypertension and 67 age-matched normotensive men (diastolic pressure, 85 to 94 and < 80 mm Hg, respectively) were recruited from a population screening program. Titers of antibodies to HSP65 were determined by enzyme-linked immunosorbent assay. The presence of carotid atherosclerosis was determined by B-mode ultrasonography. Twenty-seven individuals had atherosclerotic plaques: 48 were smokers (more than one to two cigarettes per day). Borderline hypertensive men had higher anti-HSP65 reactivity than normotensive control subjects (P = .034). Smokers with atherosclerosis had low levels of antibodies to HSP65 compared with nonsmokers with atherosclerosis (P = .002). Furthermore, when high-risk individuals (borderline hypertension plus plaque, n = 15) were compared with matched low-risk individuals (normotensive with no plaque, n = 15), the high-risk men had significantly enhanced antibody titers to HSP65 (P = .041). In conclusion, we demonstrate that serum antibody titers to HSP65 are enhanced in individuals with borderline hypertension, which may indicate an ongoing immune reaction in the artery wall.

Adult↗
PubMed1997

Nasal potential difference in cystic fibrosis patients presenting borderline sweat test.

The diagnosis of cystic fibrosis (CF) can be difficult if the sweat test and routine deoxyribonucleic acid (DNA) analysis are inconclusive. Under these circumstances, measurement of nasal potential difference (NPD) was proposed as a complementary diagnostic tool, as demonstrated in subjects bearing the G551S or 3849+10KbC-->T mutations. The purpose of the present study was to verify the diagnostic value of this technique in CF patients with a borderline sweat test. NPD was measured in 18 patients with a borderline sweat test, in whom CF diagnosis was based on the presence of one CF gene mutation in each chromosome (CF borderline). These patients were compared both to non-CF controls and CF patients with an abnormal sweat test (CF controls). Basal NPD values of CF borderline patients (mean value -39+/-6 mV, range -29 to -52 mV; n=18) were in the pathological range of CF controls (-39+/-8 mV, range -28 to -57 mV; n=37), and both were statistically different from values obtained in non-CF controls (-15+/-4 mV, range -6 to -23 mV; n=24; p<0.0001). Mutation analysis confirmed a high frequency of the 3849+10KbC-->T mutation in this group of CF borderline patients (positive in 14 out of 18 subjects), whereas other mutations, such as AF508, Q552X, N1303K and R1162X, were also found to be associated with this atypical CF phenotype. These results confirm the presence of pathological values of basal NPD in CF patients with borderline sweat test, and also extend this finding to subjects bearing genotypes other than the G551S and 3849+10KbC-->T mutations. The present findings, therefore, confirm the usefulness of measurement of basal nasal potential difference in all those patients in whom diagnosis of cystic fibrosis can be suspected but the sweat test remains inconclusive.

Adolescent↗
PubMed1982

Augmented sympathetic nervous function in young subjects with borderline hypertension.

In order to elucidate the mechanism of blood pressure elevation in the patients with borderline hypertension, the sympathetic nervous activity was investigated and the following results were obtained: 1) Plasma catecholamine (CA) levels were elevated in young men but not in middle-aged men with borderline hypertension in comparison with age-matched normal men. 2) Cardiovascular responsiveness to exogenous CA was not augmented in young men with borderline hypertension. 3) Cerebrospinal fluid noradrenaline levels were elevated in young men with borderline hypertension. They correlated positively with plasma NA or blood pressure. 4) In young men with borderline hypertension, plasma and urinary CAs were not altered by hypertonic saline loading. These results suggest that increased activity of the central and peripheral sympathetic nervous system is an important mechanism of blood pressure elevation in young subjects with borderline hypertension.

Adult↗
PubMed1983

Neurohumoral factors in borderline hypertension.

Role of neurohumoral factors in borderline hypertension was evaluated in comparison to those in established hypertension. Although there was no significant difference in urinary noradrenaline between the 2 groups, urinary adrenaline was significantly higher in borderline hypertension than in established hypertension. During head-up tilt and Schellong's test a significant increase of diastolic blood pressure was demonstrated in borderline hypertension, whereas a significant decrease of systolic blood pressure was observed without any significant change of diastolic pressure in established hypertension. There was no significant difference in blood pressure response to cold pressor test, plasma volume, total body potassium and plasma renin activity (PRA) between the 2 groups. Blood pressure did not change after administration of captopril in normal subjects but it decreased significantly after captopril in patients with borderline hypertension even when blood pressure became normotensive during hospitalization. Blood pressure decreased significantly after captopril in patients with established hypertension. However, no significant relationship between the pretreatment PRA and the reduction of mean blood pressure was observed in both groups. It can be concluded from the present study that borderline hypertension is intermediate between normal subjects and established hypertension and that both the renin-angiotensin system and the kinin-prostaglandin system play some role in the maintenance of blood pressure in borderline hypertension.

Adolescent↗
PubMed1978

Role of autonomic and non-autonomic circulatory components in borderline hypertension in young men.

The role of autonomic nervous system and non-autonomic components in hemodynamic abnormalities of young patients with borderline hypertension was examined by comparing the effects of sequential pharmacological autonomic blockade on hemodynamics between 8 patients with borderline hypertension (mean age 20.0 +/- 0.2) and 10 normotensive subjects (mean age 19.3 +/- 0.2). Propranolol (0.2 mg/Kg), atropine (0.04 mg/Kg), and phenotolamine (10 or 15 mg) were given intravenously in that order to produce "total" autonomic blockade. Increased cardiac index, heart rate, and mean arterial blood pressure with normal peripheral vascular resistance were noted at rest in patients with borderline hypertension. Cardiac index and heart rate in patients with borderline hypertension were normalized by propranolol, but after "total" autonomic blockade mean arterial blood pressure and peripheral vascular resistance were higher in patients with borderline hypertension as compared to those in normotensive subjects. These results suggest that, although autonomic nervous system control of circulation is abnormal, non-autonomic components play an important role in maintaining increased peripheral vascular resistance in borderline hypertension in young men.

Adult↗
PubMed1996

Impaired glucose tolerance at five-year follow-up of young men with borderline hypertension.

BACKGROUND: Recent studies suggest that patients with essential hypertension have impaired glucose tolerance and are hyperinsulinemic compared with normotensive subjects. The aims of the study were (1) to follow blood pressures of 56 young men with borderline hypertension for 5 years, (2) to investigate glucose tolerance in these subjects, and (3) to determine the relation of insulin/glucose metabolism to structural vascular changes and hemodynamic patterns in borderline hypertension. METHODS: Thirty-nine young (age 22-34 years) male subjects with borderline hypertension (SBP 140-160 and or DBP 85-95 mmHg initially) and 17 normotensive control subjects (SBP 110-130 and DBP 60-80 mmHg) participated in the study. Blood pressure was measured, a standard oral glucose tolerance test (OGTT) was performed, and glucose, insulin and C-peptide were determined before and 30, 60, 90 and 120 minutes after a standard 75-g glucose load. Post-ischemic forearm vasodilatory responses were examined by plethysmography. RESULTS: At follow-up, the borderline hypertensives had maintained significantly higher blood pressures than control subjects. Borderline hypertensives also had significantly impaired glucose tolerance compared to control subjects. The insulin response had a somewhat more sluggish descent, but did not differ significantly from the response of normotensives. The C-peptide response pattern resembled that of insulin, but C-peptide was significantly elevated after 120 min. On the whole group level, there were only weak relations of insulin to blood pressure. By contrast, fasting insulin and post-load insulin levels were strongly correlated with body mass index, the waist-hip circumference ratio, triglyceride, and both total and LDL cholesterol. Across the whole group, there were significant correlations between forearm minimal vascular resistance and fasting insulin (r = +0.37 p = 0.007) and insulin area-under-the-curve (r = +0.28 p = 0.044). However, Rmin was even more strongly correlated with body mass index, suggesting that this relationship was related to degree of obesity. CONCLUSION: Borderline hypertension in young men is a persistent condition which is associated with impaired glucose tolerance without hyperinsulinemia. This finding suggests that impaired glucose tolerance might be a more primary phenomenon in early hypertension devoid of lipid metabolic aberrations.

Adult↗
PubMed2006

Borderline personality symptomatology and employment disability: a survey among outpatients in an internal medicine clinic.

OBJECTIVE: The relationship between borderline personality symptomatology and employment disability has undergone limited study. Four previous studies indicate a possible relationship, but each has its own inherent limitations. In the present study, we examined this relationship among 94 internal medicine outpatients. METHOD: Using a sample of convenience, we administered 2 self-report measures for borderline personality (the Personality Diagnostic Questionnaire-4th Edition, which is based on DSM criteria, and the Self-Harm Inventory, which correlates with scores on the Diagnostic Interview for Borderlines) and inquired about the lifetime presence and length of either psychiatric or medical disability. The study was active from February 2003 through January 2005. RESULTS: There was a significant and positive correlation between scores on both borderline personality measures and the length of psychiatric disability for women (r = .33, r = .36, p = .05); however, no significant relationship was found between scores on either measure for borderline personality and the length of either psychiatric or medical disability for men. CONCLUSIONS: These findings suggest that, in contrast to men, there may be a relationship between borderline personality symptomatology and psychiatric disability only among women (i.e., there may be a gender difference). We discuss the possible implications of these results.

Journal Article↗
PubMed1981

Do borderline hypertensive patients have labile blood pressure?

The 24-hour patterns of ambulatory blood pressure were investigated in borderline (labile) hypertensive patients (office blood pressures fluctuating about 140/90 mm Hg). Sixty-three patients (21 normotensive, 21 borderline hypertensive, and 21 fixed hypertensive) had blood pressures recorded every 7.5 to 15 minutes using noninvasive automatic recorders. The mean 24-hour blood pressures (normotensive, 115 +/- 14/74 +/- 12 mm Hg; borderline hypertensive, 127 +/- 16/81 +/- 13 mm Hg; fixed hypertensive, 143 +/- 17/91 +/- 12 mm Hg) were significantly different from each other (p less than 0.005), but the standard deviations were not significantly different. The percentages of elevated blood pressures on the 24-hour recordings of the borderline hypertensive patients were intermediate between those of the normotensive and fixed hypertensive patients, but within the borderline group there was a broad range in percentage of elevated blood pressures (7.9% to 81.2%). Thus, borderline hypertensive patients have blood pressures no more labile than those in normotensive or fixed hypertensive patients, but because of their broad range of percentage of elevated blood pressures, their pressures are best evaluated with multiple measurements.

Adult↗
PubMed1999

Volume-corrected mitotic index and p53 immunoreactivity in borderline and malignant epithelial ovarian tumors.

OBJECTIVE: To determine if there are differences in p53 immunoreactivity and proliferation rate using the volume-corrected mitotic (M/V) index between borderline and malignant ovarian tumors. STUDY DESIGN: Thirteen borderline (7 serous and 6 mucinous) and 17 malignant (14 serous and 3 mucinous) ovarian neoplasms were included in this study. M/V index was calculated according to the formula of Haapasalo et al. Formalin-fixed, paraffin-embedded tissue sections were immunostained with a monoclonal antibody against p53 protein using an avidin-streptavidin method. RESULTS: Carcinomas had a considerably higher M/V index (17.7 +/- 9.8) than borderline tumors (1.5 +/- 1.7, P < .001). The usual mitotic index was also higher in carcinomas than in borderline tumors (24.9 +/- 16.6 versus 1.6 +/- 1.9, P < .001). p53 Immunoreactivity was found in 5/17 carcinomas (29.4%), while all borderline tumors were negative. CONCLUSION: Even though the number of our cases was too small to draw definitive conclusions, our results suggest that M/V index and p53 immunoreactivity may be of some help in the differentiation between borderline and malignant ovarian epithelial tumors.

Adenocarcinoma, Mucinous↗
PubMed2000

[Clinical behavior of serous and mucinous borderline tumors of the ovary with diploid DNA stem line. Follow-up studies after organ preserving and non-organ preserving therapy].

Even today, the situation is still unclear with regard to the radicality of the operation and any adjuvant therapy required in treatment of borderline tumors of the ovary. In the last two decades, treatment of these tumors in the Department of Gynecology and Obstetrics at our hospital has depended on the stage of the disease and the age of the patient. It ranged from laparoscopic cyst extirpation to hysterectomy with bilateral adnectomy and omental resection and regional lymphnodectomy. From the end of 1985 to the end of 1992, 35 patients with borderline tumors of the ovaries were operated on. Histologically, 14 borderline tumors were mucinous, 21 were serous. A follow-up investigation was carried out five to 11 years after primary operation. In this period, no patient died of borderline tumor. Twenty-eight patients who were followed up were clinically free of recurrence, five patients are alive, but could not be followed up. Two patients have died of other diseases after five years. Only one patient received adjuvant chemotherapy. She could not be followed up. In the meantime, peritoneal implants were demonstrated at second-look laparoscopies in four out of 18 patients. Later, these could no longer be demonstrated (one patient) or did not affect the survival time (three patients) and thus ultimately was not pathologically relevant. Primarily, two of these four patient had stage Ia-Ic. The paraffin blocks of the preparations are still available from 26 patients, and additional investigations could be carried out. Nineteen percent of the borderline tumors showed micropapillary structures of an MPCS (= micropapillary serous carcinoma), which evidently did not have a negative effect on the prognosis. All borderline tumors showed diploid distributions in DNA cytometry. It is not possible to make a definitive treatment recommendation on the basis of this investigation because the number of patients followed up was too small.

Adult↗
PubMed2000

DNA ploidy analysis of borderline epithelial ovarian tumours.

OBJECTIVE: Borderline epithelial ovarian tumours not uncommonly pose a great difficulty to surgical pathologists as morphologically they may show very similar features as those of malignant epithelial tumours except invasion. However it is important to separate these from their invasive counterparts because of their superior prognosis. Recently, attention has been focussed on the prognostic value of flow cytometric analysis of DNA ploidy in borderline epithelial ovarian tumours. The purpose of this study is to investigate whether flow cytometric analysis of cellular DNA content acts as a useful adjunct to the histopathological diagnosis of borderline malignancy. MATERIALS AND METHODS: Fifteen histologically confirmed borderline serous epithelial tumours of the ovary were selected. Samples were analyzed on a FACScan flow cytometer using the software MODFIT. A total of 10,000 nuclei were counted each time. RESULTS: The mean CV for the 15 cases was 3.67 (Range 2.4-5.0). In the DNA histograms a diploid sample was defined as one that had a single Go/Gl peak. An aneuploid tumour was defined as one that displayed an additional distinct peak. All 15 cases of borderline serous epithelial tumours showed a diploid stemline with DNA index between 0.9-1.10. CONCLUSION: This study suggests that aneuploidy if ever demonstrated in histologically confirmed borderline tumours should prompt extensive sampling of the tumour and a close follow up.

Aneuploidy↗
PubMed2005

A retrospective study of 32 borderline ovarian tumours: the experience of a non-specialized centre.

BACKGROUND: We evaluated the clinical features and treatment of patients with borderline ovarian tumors. METHODS: This was a retrospective review of the charts of 32 patients with borderline ovarian tumours that underwent surgery at the Department of Obstetrics and Gynaecology, Tzaneio General Hospital of Piraeus, over a 14-year period (1/1990-12/2003). RESULTS: Of the patients 62.5% were pre- or peri-menopausal. Mean age was 41.6 years. Five patients (15.63%) had undergone pelvic surgery (caesarean section not included) for unrelated reasons prior to the diagnosis of borderline tumour. Mean follow-up was 71.37 months and all patients showed up for their scheduled appointment during the first trimester of 2004. Pain was the presenting symptom in 37.5% (12/32) of patients. Twenty patients were diagnosed either by ultrasound (12.5%, 4/32) or during unrelated surgeries (50%, 16/32) and reported no relevant symptoms at the time of diagnosis. Treatment was conservative, comprised of either cystectomy (3/32), unilateral salpingo-oophorectomy (13/32), and unilateral salpingo-oophorectomy with myomectomy (1/32). Abdominal hysterectomy with bilateral salpingo-oophorectomy was performed in 15 patients for unrelated conditions (uterine pathology). Mucinous borderline tumours were identified in 11 patients (34.38%), serous borderline tumours in 17 patients (53.12%), and nonserous-mucinous borderline tumours in four patients (12.5%). Omentectomy was performed in two cases, biopsy of the controlateral ovary was performed in five cases and peritoneal washing in eight cases. Restaging surgery was performed at the Metaxa Anticancer Piraeus Hospital in 11 patients (34.38%). One patient who did not undergo a restaging operation had a recurrence of the disease. CONCLUSION: Suboptimal staging remains a major problem during the initial operation in non-specialized centres in gynaecologic malignancies.

Adenocarcinoma↗
PubMed2005

[Safety and effectiveness of pharmacologic versus mechanical stabilization of borderline coronary lesions in patients with acute coronary syndromes].

INTRODUCTION: Borderline coronary lesions are responsible for about 80% of acute coronary syndromes (ACS). Statins have been found to improve long-term prognosis in patients with coronary artery disease due to plaque stabilization. There are no reports on the frequency of new events caused by progression of borderline lesions in patients with (ACS). Percutaneous coronary intervention (PCI) as a method of mechanical stabilization of borderline coronary lesions could be an alternative to pharmacological approach. AIM: To compare the efficacy of pharmacological and mechanical stabilization of borderline plaques (DS = 40-60%) in patients with ACS. PATIENTS AND METHODS: Patients with ACS and angiographically documented borderline lesions, related to the ACS or located in other coronary arteries were enrolled. Patients were randomized to receive pharmacotherapy without intervention or to undergo PCI. The primary end-point was rate of target lesion revascularization with PCI or coronary bypass grafting (CABG) caused by progression of coronary stenosis or in-stent restenosis/thrombosis. The secondary endpoint was incidence of major adverse cardiac events (MACE) at long-term follow-up (death, ST segment elevation acute coronary syndrome--STEACS and non-ST segment elevation acute coronary syndrome-- NSTEACS). RESULTS: Pharmacological stabilization was used in 50 patients, mean age 56.7 +/- 9.14 years, whereas 44 patients, mean age 57.2 +/- 10.4 years, underwent plaque stabilization with PCI. At follow-up (mean 521 days) target lesion revascularization was performed in 3 patients, previously receiving pharmacotherapy, due to progression of coronary stenosis, and in 3 patients, after prior PCI, due to in-stent restenosis (7% vs. 8%, p = NS). The rate of MACE in both groups was also similar (6% vs. 5%, p = NS). CONCLUSION: There were no differences between mechanical and pharmacological stabilization of borderline coronary lesions in patients with acute coronary syndromes.

Adult↗
PubMed2005

Fractional flow reserve assessment to determine the indications for myocardial revascularisation in patients with borderline stenosis of the left main coronary artery.

INTRODUCTION: Reliable assessment of clinical significance of borderline angiographic lesions found within the left main coronary artery (LM) is often impossible. Measurement of fractional flow reserve (FFR) is commonly used to verify borderline stenoses of the coronary arteries. However, the usefulness of FFR measurements has been validated only for arteries other than the LM. AIM: Evaluation of the measured FFR value in determination of the indications for myocardial revascularisation in borderline LM stenosis. METHODS: The study involved 38 patients aged 55+/-9 years (range 41-74 years) with isolated borderline LM stenosis. Each patient had the measurement of FFR performed during intravenous adenosine infusion at a dose of 140 microg/kg/min. Patients were referred for revascularisation if FFR was <0.75. RESULTS: The mean LM stenosis in quantitative coronary angiography (QCA) was 45+/-10%. FFR<0.75 was found in 18 (47%) patients, whereas 20 (53%) subjects had FFR < or =0.75. In subjects with FFR <0.75 QCA showed significantly lower minimal lumen diameters (MLD) at the site of stenosis (1.84+/-0.45 vs 2.24+/-0.49, p=0.014). Additionally, a significant correlation was found between FFR and MLD (r=0.59, p<0.001). The mean clinical follow-up was 2 years (range 1-3 years). There were two (11%) fatal events in patients with FFR < or =0.75 who underwent CABG. One (5%) patient with FFR >0.75 underwent elective CABG due to progression of LMN stenosis. Moreover, one (5%) patient experienced myocardial infarction not related to borderline stenosis of the LM. CONCLUSIONS: The measurement of FFR confirms the clinical significance of stenosis only in half of the patients with borderline isolated lesion of the left main coronary artery. Withdrawal from intervention in patients with FFR > or =0.75 is safe and is associated with favourable clinical outcomes in two-year follow-up.

Adult↗