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PubMed1996

Unusual presentation of Takayasu arteritis with cardiac involvement and imitation of juvenile arteriosclerosis. A case report.

A twenty-five-year-old Caucasian man with Takayasu arteritis, who was formerly diagnosed as suffering from premature arteriosclerosis, is described. Necropsy disclosed involvement of the entire aorta and its major branches, the pulmonary arteries, the coronary arteries, the intramyocardial arteries, and the heart valves, a combination hitherto not described. Literature concerning heart involvement in Takayasu arteritis is reviewed, and the differential diagnosis is discussed.

Adult↗

PubMed1976

Intramural coronary arteriosclerosis of normal and dwarfed swine.

Dwarfing of swine maintained in large groups with relatively little space per animal may be attributed to psychosocial factors. Intramural coronary arteriosclerosis developed at approximately the same rate in dwarfed and normally developing animals. Lesions in arteries of the left posterior papillary muscle were more advanced than in the left anterior papillary muscle of the same animal, irrespective of its growth rate, and often were more advanced than in swine twice as old.

Animals↗

PubMed1998

Dipyridamole thallium-201 single-photon emission computed tomography for prediction of perioperative cardiac events in patients with arteriosclerosis obliterans undergoing vascular surgery.

The aim of the study was to determine whether or not dipyridamole thallium-201 single-photon emission computed tomography (201Tl-SPECT) has significant additive value for predicting perioperative cardiac events in patients with arteriosclerosis obliterans (ASO) undergoing vascular surgery. Routine preoperative 201Tl-SPECT was performed in 106 consecutive patients with ASO (age 68+/-8.9 years; 91 men and 15 women). The frequency of reversible defects in a clinical high-risk group (n=44) was significantly higher than in a low-risk group (n=62; 55% vs 24%, p<0.01). Perioperative cardiac events occurred in 9 patients, including 4 cardiac deaths, 1 non-fatal myocardial infarction, and 4 cases of unstable angina. Although clinical risk stratification was useful in predicting cardiac events (19% in the high-risk group vs 2% in the low-risk group, p<0.01), the positive predictive value was low. When considering a combination of 2 or more than 2 risk factors and a large reversible defect as a predictor, the positive predictive value and specificity increased from 19% to 47% and from 64% to 91%, respectively, whereas the sensitivity remained unchanged (89%). These results suggest that the addition of 201Tl-SPECT data to clinical risk-stratified patients with ASO allows better prediction of perioperative cardiac events.

Adult↗

PubMed2005

Hypertension is the most common component of metabolic syndrome and the greatest contributor to carotid arteriosclerosis in apparently healthy Japanese individuals.

The cluster of metabolic and hemodynamic risk factors known as metabolic syndrome is known to be a risk factor for ischemic cardiovascular diseases and stroke. By analyzing the cross-sectional data from 8,144 individuals (age 19-88 years) who underwent general health screening, we have investigated the prevalence of metabolic syndrome, as diagnosed by modified-National Cholesterol Education Program (NCEP) criteria corresponding to the following five categories: triglycerides > or = 150 mg/dl; high density lipoprotein (HDL)-cholesterol < 40 mg/dl in men or < 50 mg/dl in women; fasting plasma glucose > or = 110 mg/dl; systolic/diastolic blood pressure > or = 130/85 mmHg; and body mass index > 25 kg/m2. We found that the prevalence of metabolic syndrome was 19% in men and 7% in women. After adjustment for age, metabolic syndrome was found to be significantly more prevalent in men than in women, with an odds ratio of 3.08 (95% confidence interval [CI] 2.62-3.61, p < 0.0001). Among the five metabolic/hemodynamic risk factor components, hypertension was observed most frequently in individuals with metabolic syndrome, at 85% in men and 87% in women. In addition, multivariate logistic regression analysis adjusted for age, sex, serum total cholesterol levels, and smoking status showed that hypertension possessed the greatest odds ratio (1.43, 95% CI 1.27-1.60) for carotid plaque among the metabolic/hemodynamic risk factors. These data emphasize the importance of controlling blood pressure for reducing the risk of both metabolic syndrome and carotid arteriosclerosis in apparently healthy individuals.

Aged↗

PubMed2003

Coronary arteriosclerosis with myocardial atrophy in a 13-year-old dog.

Myocardial ischemia, an uncommon cause of sudden death in dogs, usually results in infarction and fibrosis of the myocardium. Necropsy examination of a 13-year-old German Shepherd dog that died suddenly demonstrated multifocal myocardial thinning and loss in the left and right ventricular free wall and right atrium. Histopathologic examination confirmed the myocardial thinning to be sites of myocyte atrophy and loss, with loose reticulin-positive fibrovascular tissue and adipocytes and little fibrosis. Many intramural coronary arteries were irregularly thickened and partially occluded by segmental intimal and medial deposits of periodic acid-Schiff-positive, Congo red-negative amorphous extracellular material. This finding is consistent with hyaline arteriosclerosis. These vascular lesions likely lead to insufficient perfusion of the affected myocardium and gradual loss of myofibers without the acute necrosis and fibrosis characteristic of infarction.

Animals↗

PubMed2004

Gene therapy for heart transplantation-associated acute rejection, ischemia/reperfusion injury and coronary arteriosclerosis.

Acute cardiac allograft rejection is still a major complication after heart transplantation. Acute rejection usually responds to conventional immunosuppressants, however, the nonspecific nature of the immunosuppression and the toxicities of the drugs can be life threatening and may compromise the recipient's quality of life. In addition, cardiac allograft arteriosclerosis or chronic rejection limits the long-term survival of recipients. Such conditions cannot be prevented with conventional therapies. To overcome acute and chronic rejection of cardiac allograft as well as ischemia/reperfusion injury associated with organ preservation many novel approaches have been proposed. Gene transfection of the donor organ during organ preservation is an attractive method, because the transfected genes would not affect recipients and treatment could be delivered specifically to the site of inflammation. This method could be useful to prevent graft failure without systemic adverse effects. Here we shall review current advances in gene therapies to prevent and treat organ failure of transplanted allografts.

Animals↗

PubMed2000

Host CD40 ligand deficiency induces long-term allograft survival and donor-specific tolerance in mouse cardiac transplantation but does not prevent graft arteriosclerosis.

Although interruption of CD40-CD40L interactions via their respective mAbs yields prolonged allograft survival, the relative importance of CD40 or CD40L on donor or host cells remains unknown. Moreover, it is uncertain whether any allospecific tolerance occurring with CD40-CD40L blockade will also prevent allograft arteriopathy, the major long-term limitation to transplantation. Therefore, we performed cardiac transplantations using CD40L-deficient (CD40L-/-) mice to investigate the mechanisms underlying prolonged allograft survival. Without immunosuppression, wild-type (WT) hosts rejected allo-mismatched WT or CD40L-/- heart allografts within 2 wk. Conversely, allografts in CD40L-/- hosts beat vigorously for 12 wk. Anti-CD40 treatment did not induce graft failure in CD40L-/- recipients. Although graft-infiltrating cells were reduced approximately 50% in CD40L-/- hosts, the relative percentages of macrophages and T cell subsets were comparable to WT. IFN-gamma, TNF-alpha, and IL-10 were diminished commensurate with the reduced cellular infiltrate; IL-4 was not detected. CD40L-/- recipients did not develop IgG alloantibodies and showed diminished B7 and CD28 expression on subsets of graft-infiltrating cells. CD40L-/- transplant recipients developed allospecific tolerance to the donor haplotype; second set donor skin grafts engrafted well, whereas third-party skin grafts were vigorously rejected. By MLR, splenocytes from CD40L-/- allograft recipients also demonstrated allo-specific hyporesponsiveness. Nevertheless, allografts in CD40L-/- hosts developed significant graft arteriosclerosis by 8-12 wk posttransplant. Therefore, we propose that early alloresponses, without CD40-CD40L costimulation, induce allospecific tolerance but may trigger allo-independent mechanisms that ultimately result in graft vasculopathy.

Animals↗

PubMed1976

Haemodynamics and myocardial metabolism in patients with obliterative coronary arteriosclerosis and tachycardia induced by pacing.

Fifty-three men with significant obliterative arteriosclerosis of coronary arteries were examined at rest, during and after pacing. Pacing induced both angina pectoris and depression of the ST segment in 38% of the patients; either angina pectoris or depression of ST segment, in 32% of the patients; the remaining 30% of patients were without symptoms or ECG signs of coronary insufficiency. Haemodynamic findings at rest, or during and after cessation of pacing were not different between these groups. Pacing increased heart rate, cardiac index remained unchanged, the stroke volume decreased, the left ventricular ejection time shortened. In both systemic and pulmonary arteries the systolic pressures decreased, the diastolic and mean pressures rose. The left ventricular end-diastolic pressure decreased. In 28 of the patients the myocardial metabolism was investigated. A close correlation was found between positive symptoms and ECG signs of myocardial ischaemia on the one hand, and metabolic signs on the other hand. Absence of angina pectoris and depressions of the ST segment during pacing does not exclude the presence of metabolic signs of ischaemia; an opposite finding is about three times less frequent. The study offers objective information about haemodynamics and myocardial metabolism before, during and after pacing, and represents an attempt of a simple classification of symptoms and signs of induced ischaemia.

Adult↗

PubMed2001

Myocardial scintigraphy correlates poorly with coronary angiography in the screening of transplant arteriosclerosis.

BACKGROUND: Coronary angiography remains an important screening tool for transplant coronary arteriosclerosis (TxCAD) after heart transplantation despite criticism that it underestimates the incidence of TxCAD. In an effort to improve TxCAD incidence estimation, several methods of screening have been proposed. In the present study, the incidence of TxCAD assessed by both yearly coronary angiography and stress myocardial scintigraphy imaging was reviewed. PATIENTS AND METHODS: Ninety-nine consecutive primary heart transplantations were performed from 1988 to 1999. The standard immunosuppression protocol consisted of the introduction of antilymphocyte globulin and steroids, while maintenance therapy was with cyclosporine, imuran and steroids. Coronary angiography and a stress 2-methoxyisobutyl-isonitrile perfusion scan were performed yearly. TxCAD was defined by angiographic evidence of luminal abnormality by catheterization, or a perfusion abnormality at rest or after stress on myocardial scintigraphy. RESULTS: The mean recipient age was 49+/-12 years and the mean donor age was 33+/-13 years. The etiology of heart failure was ischemic cardiomyopathy (50%), dilated cardiomyopathy (41%) and congenital heart disease (9%). The freedom from angiographic TxCAD was 92% at one year, 64% at five years and 35% at eight years. The freedom from nuclear imaging TxCAD was 92% at one year, 69% at five years and 44% at eight years. However, a diagnosis of TxCAD by angiography only correlated with a diagnosis of TxCAD by nuclear imaging 52.8% of the time in the same patient, with a median time between studies of one month. CONCLUSION: The overall incidence of TxCAD diagnosed by angiography and nuclear imaging appears similar but correlates poorly in patients, casting doubt on the routine use of myocardial scintigraphy for screening TxCAD.

Adolescent↗

PubMed1975

Arteriosclerosis of coronary arteries in sudden, unexpected deaths.

The authors graphically studied the topographic pattern and severity of coronary arteriosclerosis in arteriosclerotic heart disease (ASHD) sudden deaths using an improved technique involving in toto removal and decalcification of the main coronary tree. The study involved 171 cases of ASHD sudden death and 154 deaths from other causes. White males were the most severely affected group. The majority of the ASHD deaths had three or four major coronary vessels showing greater than 75% luminal stenosis; single-artery disease was a rare occurence. The intra- and interarterial pattern of coronary stenosis was equally severe and diffuse, with the exception of the arteries to SA and AV nodes. No small intramyocardial blood vessel disease was evident. Severe chronic coronary stenosis was associated with a high incidence of old myocardial infarction. The anatomical and pathological pattern of coronary stenosis in ASHD deaths appears to have ominous therapeutic implications.

Adult↗

PubMed2004

Inhibition of graft coronary arteriosclerosis after heart transplantation.

Graft coronary arteriosclerosis (GCA) is the leading cause of long-term mortality after heart transplantation (HTx). The goal of this study was to demonstrate that inhibition of immunemediated injury by cyclosporine (CsA) protects the allograft from GCA. ACI-to-Lewis rat allografts were disparate in major and nonmajor histocompatibility loci. Isografts (Lewis-Lewis) were controls. Treatment groups received either olive oil or CsA at 2.5, 5, 10, or 20 mg/kg/day for 3 months. Histology (elastin) and immunohistochemistry using monoclonal antibodies to CD4, CD8, CD45R, RT1B, CD11b/c, CD25, and alpha-actin was performed to examine the epicardial and intramyocardial coronary arteries. Computerized image morphometry was utilized to measure intimal and medial thickness and area. Rats receiving olive oil or CsA at 2.5 mg/kg/day had severe rejection and no graft survival. CsA at 5 mg/kg/day resulted in less severe rejection with significant intimal and medial proliferation (P < 0.001). CsA at 10-20 mg/kg/day paralleled Lewis-Lewis isograft outcomes and inhibited arteriosclerotic vascular changes in the allograft (P < 0.001). Perivascular T-helper cells and macrophages were a characteristic finding with low-dose CsA but rare with higher CsA doses. In this new model of accelerated GCA in rats, immune-mediated antigen-dependent vasculopathy as a result of inadequate immunosuppresion is fundamental in the development of GCA, which appeared equally in epicardial arteries and intramyocardial arterioles. CsA prevents GCA in a dose-dependent fashion in the rat allograft.

Animals↗

PubMed1991

[Lipoproteins (A) after a history of myocardial infarction, arteriosclerosis obliterans, hypertension and hyperlipidemia].

Serum lipoprotein(a) concentration in men with hypertension, arteriosclerosis obliterans, hypercholesterolemia and after myocardial infarction was measured using Laurell's immunoelectrophoresis. Lp(a) distribution and mean serum concentrations did not differ significantly from the controls, with the exception of a group of premature myocardial infarction (age below 45), in which high values were more frequent.

Adult↗

PubMed1991

Human coronary transplantation-associated arteriosclerosis. Evidence for a chronic immune reaction to activated graft endothelial cells.

Occlusive disease of coronary arteries of engrafted hearts is the major obstacle to long-term survival of human cardiac allografts. The pathogenesis of this process remains uncertain. The identity and localization of cells found in transplantation-associated arteriosclerosis lesions from human cardiac allografts were evaluated, and their expression of class II major histocompatibility complex (human leukocyte antigen-DR [HLA-DR]), surface molecules required for recognition of foreign cells by CD4+ T lymphocytes, was noted. Expanded intimas of transplanted coronary arteries contain T lymphocytes (both CD4+ and CD8+ in approximately equal number) and HLA-DR+ macrophages, both localized primarily in a ring immediately below the luminal endothelium, a distribution strikingly different from that in typical atherosclerosis. Coronary arterial endothelium from six of six transplanted hearts studied bore high levels of HLA-DR. Normal human arteries or usual atherosclerotic lesions have few if any HLA-DR+ endothelial cells. The significance of these findings was tested by evaluating the ability of HLA-DR+ arterial cells to interact with allogeneic T cells in vitro. Endothelial cells (but not smooth muscle cells) cultured from human arteries stimulated foreign CD4+ T cells to proliferate and augmented their secretion of interleukin-2. These findings suggest that ongoing stimulation of recipient T lymphocytes by HLA-DR+ endothelium of donor coronary arteries contributes to a sustained regional immune response. Consequent local release of cytokines may regulate smooth muscle cell proliferation and matrix accumulation within the coronary arteries of allografted hearts.

CD4 Antigens↗

PubMed1988

[Serum magnesium and heart arrhythmias in patients with pelvic-leg arteriosclerosis].

In 122 male patients with arteriosclerosis of pelvis and legs up to 5 resting electrocardiograms were registered in the course of 4 years. 5.2% of these electrocardiograms showed disturbances of rhythm. In these cases no significant differences in the serum magnesium level could be ascertained between patients with and without disturbances of rhythm.

Arrhythmias, Cardiac↗

PubMed1986

[Behavior of the trace element chromium in coronary arteriosclerosis].

The present literature is submitted to a searching examination concerning the behaviour of the trace element chromium in coronary arteriosclerosis. Since 1978 chromium has been determined by three research groups in the plasma or serum of patients with ischaemic heart disease, in which cases their results are contradictory. The reason is evident: it is difficult to measure reliably the element chromium and the appearing problems are occasionally underestimated. Reliable and reproducible determinations of chromium demand especially equipped laboratories in order to avoid the contamination of tests, a sensitive and specific equipment and above all very experienced analyticians.

Chromium↗

PubMedDate not supplied

Arterialization of the coronary veins in diffuse coronary arteriosclerosis.

Since the coronary veins and capillaries are not involved with arteriosclerotic disease the authors performed experimental, and afterwards, clinical total and selective coronary vein arterialization. Acute myocardial ischaemia created for instance by ligation of the anterior descending branch, was treated by an internal mammary artery to regional coronary vein anastomosis. In 21 patients the selective arterialization of the "Vena cordis magna" or of "Vena cordis media", and total arterialization of the coronary sinus was performed. The clinical improvement and follow-up studies seem to be promising in the treatment of patients with advanced diffuse heavy coronary arteriosclerosis. In acute myocardial ischaemia with coronarographically localized coronary occlusion, the aim of regional vein arterialization is to minimize the area of infarction.

Adult↗

PubMed1980

[HDL cholesterol as a risk factor for arteriosclerosis (author's transl)].

Recent studies have demonstrated a negative correlation between the cholesterol content of the HDL fraction of serum lipoproteins and the incidence of arteriosclerosis. In this study the limits of normality of HDL-cholesterol have been determined in a male and female population, followed by an analysis of the HDL-cholesterol in patients with myocardial infarction. Normal values for total cholesterol in males and females were, respectively, 194.7 +/- 61.8 mg/dl and 188 +/- 62.8 mg/dl, and those of HDL-cholesterol, 63.1 +/- 14.6 mg/dl and 70.3 +/- 24.4 mg/dl. Total cholesterol in the patients with myocardial infarction was not significantly different from that of the control group, but HDL-cholesterol was significantly lower (p < 0.05).

Adult↗

PubMed1996

Blood pressure in young adults with and without a paternal history of premature coronary heart disease in Europe: the EARS Study. European Arteriosclerosis Study.

OBJECTIVE: The European Arteriosclerosis Study (EARS) was designed to identify variables which discriminate subjects with a paternal history of premature coronary heart disease (CHD) from controls and to study the distribution of these variables across Europe. In this article we report on the blood pressure (BP) data. DESIGN: Comparison of young individuals (18 to 26 years) from 14 different European universities with and without paternal history of premature (before 55) myocardial infarction (MI). SUBJECTS AND METHODS: 1994 university students were recruited, 682 with a positive paternal history of premature MI (cases) and 1312 age and sex-matched controls. Following a rigid fieldwork and analyses protocol, data on life style, BP, anthropometric and analytical measurements were obtained. RESULTS: Only diastolic BP in female patients was different between cases and controls (P < 0.05). A significantly higher prevalence of high BP personal history in male cases than in controls was observed (P < 0.02). BP means showed significant regional differences with higher values in the northern and middle European countries respect to southern regions (P < 0.0001). BP values were positively correlated to body mass index (BMI) and waist to hip (W/H) ratio, no correlations were observed with alcohol consumption in this age group. Tobacco showed a negative independent correlation with both systolic and diastolic BP (P < 0.0001). The use of contraceptive pills was associated with higher systolic (P < 0.0001) and diastolic (P < 0.05) BP levels. After adjustment for covariants, only weak correlations were observed between BP, lipids and apolipoproteins. Apo E showed a positive correlation with BP. Lp(a) and fibrinogen showed no significant regression coefficients with BP. Among cholesterylesters, oleic acid percentages were negatively correlated to BP values (mainly diastolic BP: P < 0.001), while the correlation with linoleic acid was positive (P < 0.001). Fasting glucose levels showed an independent correlation with systolic BP (P < 0.0001) in a multiple regression analysis. CONCLUSIONS: In the group with paternal history of premature MI, the higher prevalence of personal history of high BP in males and the higher diastolic BP values in females suggest that high BP could play a role in the elevated CHD risk of this group. Epidemiological observations on BP distribution and its relation with anthropometric and biochemical covariants in a young group of age from different European countries are reported.

Adolescent↗