Ari Mandil

Carotid intimal-medial thickening and endothelial function in coronary artery disease

OBJECTIVE To investigate the correlation between the endothelial function and the carotid intimal-medial thickening (IMT) in a population of patients with coronary artery disease, as well as that between the endothelial function and carotid IMT with the severity of the coronary lesions. METHODS Forty-three patients aged 60.5+/-9.2 years, (67.4% males) with coronary artery disease at the coronariography were studied. Endothelial function was assessed using the brachial artery reactivity test (BART), which measured the percentage of flow-mediated dilatation (%FMD). The carotid IMT was evaluated through vascular ultrasound. RESULTS The mean %FDM was 4.7 +/- 3.6 and the mean carotid IMT was 1.08 +/- 0.23 mm. The carotid MIT and %FMD measurements showed a statistically significant correlation, with Spearmans coefficient of 0.315, p= 0.042, demonstrating that lower %FMD values corresponded to an increased carotid IMT (r = -0.315, p = 0.042). There was no correlation between %FMD or IMT and the severity of coronary lesions. CONCLUSIONS The presence of a correlation between carotid IMT and %FMD demonstrates a concomitance of anatomical and functional vascular alterations in coronary artery disease, regardless of the severity of the atherosclerotic lesions.

Valvuloplastia aórtica por balão como ponte para o tratamento definitivo na estenose aórtica grave

In a 36-year-old man with severe aortic stenosis and refractory cardiogenic shock, an emergency percutaneous balloon aortic valvuloplasty was performed, followed by clinical improvement, allowing elective aortic valve replacement at the 48th day post-valvuloplasty. Clinical follow-up for eight months after surgery showed significant functional improvement. Aortic balloon valvuloplasty is a life-saving approach to patients with severe aortic stenosis and high surgical risk and should be considered as a bridge to planned valve replacement or cardiac transplantation. Aortic valve replacement should be considered even in patients with severe ventricular dysfunction, while the cardiac transplantation should be indicated for patients with a very marked and irreversible depression of myocardial contractility.

Human Tissue Kallikrein Activity in Angiographically Documented Chronic Stable Coronary Artery Disease

Background Human tissue kallikrein (hK1) is a key enzyme in the kallikrein–kinin system (KKS). hK1-specific amidase activity is reduced in urine samples from hypertensive and heart failure (HF) patients. The pathophysiologic role of hK1 in coronary artery disease (CAD) remains unclear. Objective To evaluate hK1-specific amidase activity in the urine of CAD patients Methods Sixty-five individuals (18–75 years) who underwent cardiac catheterism (CATH) were included. Random midstream urine samples were collected immediately before CATH. Patients were classified in two groups according to the presence of coronary lesions: CAD (43 patients) and non-CAD (22 patients). hK1 amidase activity was estimated using the chromogenic substrate D-Val-Leu-Arg-Nan. Creatinine was determined using Jaffé’s method. Urinary hK1-specific amidase activity was expressed as µM/(min · mg creatinine) to correct for differences in urine flow rates. Results Urinary hK1-specific amidase activity levels were similar between CAD [0.146 µM/(min ·mg creatinine)] and non-CAD [0.189 µM/(min . mg creatinine)] patients (p = 0.803) and remained similar to values previously reported for hypertensive patients [0.210 µM/(min . mg creatinine)] and HF patients [0.104 µM/(min . mg creatinine)]. CAD severity and hypertension were not observed to significantly affect urinary hK1-specific amidase activity. Conclusion CAD patients had low levels of urinary hK1-specific amidase activity, suggesting that renal KKS activity may be reduced in patients with this disease.

Aplicações do Balão Farmacológico na Doença Arterial Coronária

As estrategias de revascularizacao percutânea evoluiram significativamente nas ultimas decadas. No entanto, toda nova tecnologia apresenta um beneficio sobre a anterior, mas traz consigo tambem novos riscos. A hiperplasia neointimal, associada aos stents nao farmacologicos, e a endotelizacao tardia das hastes e reacao inflamatoria vascular ao polimero, associada aos stents farmacologicos, sao exemplos dessa premissa. Os baloes farmacologicos foram desenvolvidos com o racional de modular a hiperplasia neointimal apos a intervencao e de nao suscitar os problemas tardios relacionados aos stents com eluicao de farmacos antiproliferativos. No entanto, as evidencias e as recomendacoes para sua utilizacao ainda nao foram adequadamente definidas. Esta revisao objetiva apresentar e caracterizar os tipos de balao farmacologico disponiveis no mercado mundial, fazendo uma revisao dos estudos mais relevantes presentes na literatura sobre seu uso nos diversos cenarios clinicos e descrever as principais indicacoes e atuais recomendacoes para seu uso.