Journal of cardiovascular medicine
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J Cardiovasc Med (Hagerstown) · Nov 2012
ReviewRemote ischemic conditioning: the cardiologist's perspective.
Early and successful restoration of myocardial reperfusion following an ischemic event is the most effective strategy to reduce final infarct size and improve clinical outcome. However, revascularization per se may induce further myocardial damage by myocardial ischemia-reperfusion injury and worsen clinical outcome. Therefore, new therapeutic strategies are required to protect the myocardium against ischemia-reperfusion injury in patients with coronary artery disease. ⋯ Large-scale multicenter clinical trials are needed to establish the role of RIC in the current clinical practice. At present, the use of RIC in acute coronary syndromes seems particularly attractive due to its potential in-ambulance application and apparent dramatic reduction in infarct size in the patients with the largest infarcts. Cardiac arrest and stroke represent ischemia-reperfusion disorders where RIC has further potential to improve outcome beyond rapid revascularization alone.
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J Cardiovasc Med (Hagerstown) · Nov 2012
Clinical characteristics and risk assessment of ST-segment elevation myocardial infarction patients of an Iranian referral center.
Cardiovascular diseases (CVDs) are the main cause of morbidity and mortality all over the world. Acute myocardial infarction (AMI) is the leading cause of death and disability in the Iranian population. This prospective comprehensive study aimed to assess the clinical characteristics and in-hospital outcomes with possible correlations between them in patients with AMI. ⋯ Our results provide emphasis on prevention of cardiovascular risk factors and further support to decrease patients' prehospital delay and accelerate in-hospital interventions for patients with AMI.
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J Cardiovasc Med (Hagerstown) · Nov 2012
α-tocopherol and ascorbic acid in early postoperative period of cardiopulmonary bypass.
To investigate whether α-tocopherol and ascorbic acid have effect on the suppression of inflammation in the early postoperative period after open heart surgery. ⋯ Suppression of the systemic inflammatory response to CPB is a double-edged sword and whether this suppression aids in the attenuation of morbidity and mortality is obscure. In this respect, ascorbic acid and α-tocopherol seem to display some anti-inflammatory effect, but further studies are necessary to reveal the actual therapeutic potential and the complex mechanism related to biochemical and inflammatory parameters.
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Intraplaque hemorrhage (IPH) is an important co-factor for plaque progression and rupture. So far noninvasive MRI has shown promise for the in-vivo identification of IPH and for the prediction of plaque instability. Intravascular imaging techniques such as intravascular ultrasound or optical coherence tomography (OCT) cannot distinguish between IPH and other plaque components. ⋯ Microvessels are known to be the main source of blood extravasation due to their anatomically compromised structure. Coronary plaques with a high microvessel density undergo rapid plaque progression and are often associated with other features of plaque instability such as inflammatory cells. The combination of data from both MRI and OCT studies will allow a better understanding of the mechanism of plaque destabilization and the pathophysiology of cardiovascular events.
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J Cardiovasc Med (Hagerstown) · Oct 2012
ReviewFrom intraplaque haemorrhages to plaque vulnerability: biological consequences of intraplaque haemorrhages.
Intraplaque hemorrhages are mainly related to inward neoangiogenesis, initiated from the adventitia by lipid-dependent outwardly convected signals, and by the immaturity of these neovessels, allowing leaks and hemorrhages. Repeated intraplaque hemorrhages play a major role in the evolution of thrombotic occlusive disease, similar to the role of intraluminal thrombus in the progression of abdominal aortic aneurysm toward rupture. Red blood cells (RBCs) are an important source of unesterified cholesterol, because their membranes are particularly cholesterol rich. ⋯ These proteases concentrate in the hemorrhagic/necrotic core rendered plaque highly vulnerable. An adaptive immune response takes place in the adventitia, in regard of hemorrhagic plaques, in relation to outwardly convected oxidized or proteolyzed neoantigens, and chemokinic signals. Finally, intraplaque hemorrhages and thrombi are the site of weak pathogen entrapment, which promote all these oxydative and proteolytic phenomenons.