Kostas Tsioufis

Perforation of a saphenous vein graft during percutaneous angioplasty: demonstration by means of intravascular ultrasound and consequent treatment with a polytetrafluoroethylene-covered stent.

We present a case of a perforation of the saphenous vein graft during percutaneous angioplasty and its subsequent implantation with a polytetrafluoroethylene-covered stent. Angiographic as well as intravascular images of the site of perforation are provided.

Insight to the Pathophysiology of Stable Angina Pectoris

Atherosclerosis is a chronic disease which mainly represents an inflammatory response in the vessels. Myocardial ischemia manifested by angina pectoris can be either acute or chronic and usually is a result of imbalance between myocardial oxygen supply and myocardial oxygen demand. Chronic stable angina is chest discomfort attributed to myocardial ischemia without the presence of necrosis and is the most common symptom encountered by emergency room physicians. A growing amount of data has shown that endothelial dysfunction, is now considered an important early event in the development of atherosclerosis, while in the absence of angiographically obstructive coronary artery disease, anginal chest pain is often attributed to microvascular coronary dysfunction. Moreover, atheroma formation and in turn, atherosclerotic plaques seem to affect coronary flow, given that multivessel flow-limiting obstructions are observed in patients with chronic coronary syndrome. Morphological changes of diseased arteries related to significant atherosclerosis, such as vascular remodeling may also result in stable angina or claudication. However, several issues with respect to the comprehension of the pathophysiology of the chronic coronary syndrome have not been fully elucidated.

Air pollution and arterial hypertension. A new risk factor is in the air

Air pollution is one of the greatest environmental threats and has been implicated for several adverse cardiovascular effects including arterial hypertension (HTN). However, the exact relationship between air pollution exposure and HTN is still unclear. Air contamination provokes oxidative stress, systemic inflammation, and autonomic nervous system imbalance that subsequently induce endothelial dysfunction and vasoconstriction leading to increased blood pressure. The aim of this review was to describe the potential mechanisms by which air pollution contributes to HTN and to summarize the consequences of short- and long-term exposure.

Hemostasis Parameters Disturbances in Healthy Individuals with Prehypertension

Prehypertension (PH) seems to be related to increased cardiovascular risk in healthy normotensive subjects, while essential hypertension is associated with hemostasis balance disturbances. The aim of our study was to examine the impact of PH on hemostasis parameters in healthy individuals with PH and to compare the findings with those of healthy normotensives with normal blood pressure (NBP) levels. This study was performed in 204 (96 M, 108 F) subjects who attended our hypertension clinic. Seventy-eight (36 M, 42 F) subjects with PH, mean age 52 ± 5 years, and body mass index (BMI) 23 ± 1.5 kg/m2 made up group A, and 126 (60 M, 66 F) subjects with NBP, mean age 53 ± 6 years, and BMI 23.2 ± 1.4 kg/m2 without any history of cardiovascular disease or diabetes mellitus made up group B. Systolic blood pressure and diastolic blood pressure were measured in three sequential visits, which were performed by the same trained nurse. Serum lipid levels, fibrinogen (F), thrombomodulin (TM), and plasminogen activator inhibitor-1 antigen, and tissue plasminogen activator antigen were determined in the whole population. Plasminogen activator inhibitor-1 antigen and tissue plasminogen activator antigen levels were significantly higher in the PH group as compared with normotensives, while in PH subjects, significantly higher plasma levels of F and TM were found compared with normotensive group. The two groups were matched for age, sex, BMI, and serum lipid levels. Our findings indicate that PH is associated with hemostasis disturbances predisposing to hypercoagulability and impaired fibrinolysis. This observation may be of prognostic value for future cardiovascular events in this group and needs further investigation.

Anomalous common origin of all coronary arteries with a common ostium from the left sinus of Valsalva.

We describe the very rare case of a middle-aged man, who was found at the catheterization laboratory to have a common origin of both left and right coronary arteries from a single ostium from the left sinus of Valsalva.

Anesthetic ointment only (lidocaine/prilocaine) instead of injectable local lidocaine in trans‐radial catheterization: A viable no‐needle alternative

OBJECTIVE The aim of the present study was to assess the level of access site pain in patients undergoing transradial coronary catheterization by using topical application of an anesthetic ointment (lidocaine/prilocaine-AO) compared to standard local anesthesia (LA) by means of injectable lidocaine. METHODS We prospectively studied 444 patients undergoing elective trans-radial coronary angiography. The quality of analgesia was assessed using a visual analogue scale (VAS) immediately after the puncture and 30 min after the removal of the sheath. The number and duration of attempts before successful sheath insertion, as well as artery spasm, were compared between the two groups. RESULTS Pain levels measured by VAS were found to be similar between the two groups during sheath insertion (VAS: AO: 4.84 ± 1.0 vs 4.82 ± 1.2, P = NS), as well as 30 min after sheath removal (VAS: AO: 0.07 ± 0.5 vs LA: 0.15 ± 0.6, P = NS). The time to obtain radial access was also not affected by the use of anesthetic ointment (AO: 62.24 ± 25.7 s vs LA: 64.04 ± 18.78 sec, P = NS). The rate of clinical or angiographic radial artery spasm was similar (8-10%) between the groups (P = NS) CONCLUSION: Use of a local anesthetic ointment, versus injectable lidocaine, in trans-radial cardiac catheterization as means of local anesthesia, was found to be equally effective in terms of pain, artery spasm, or artery cannulation speed.

Differential effects of lercanidipine/enalapril versus amlodipine/enalapril and hydrochlorothiazide/enalapril on target organ damage and sympathetic activation in non-obese essential hypertensive subjects

Abstract Objective: The aim of the present study was to compare the effects of the combination of lercanidipine/enalapril versus amlodipine/enalapril and hydrochlorothiazide/enalapril on blood pressure, target organ damage and sympathetic activation in patients with grade 2 essential hypertension. Research design and methods: This was a 3 month, randomized, blinded-endpoint study in essential hypertensive patients. Main outcome measures: Office and ambulatory blood pressure, arterial stiffness, urinary albumin to creatinine ratio, renal arterial resistive index, and muscle sympathetic nerve activity were evaluated at baseline, after a 2 week run-in placebo period, at 1 month and at 3 months. Results: In total, 56 patients were assigned to lercanidipine/enalapril (n = 19), enalapril/amlodipine (n = 18) and hydrochlorothiazide/enalapril (n = 19). Each pharmacological combination tested was effective in reducing office blood pressure at 1 month and 3 months, and 24 h ambulatory blood pressure at 3 months. Renal arterial resistive index (RI) significantly improved at 1 month and 3 months compared with baseline in all groups. However in the lercanidipine/enalapril and hydrochlorothiazide/enalapril groups, RI was favorably reduced (0.53 ± 0.03 and 0.54 ± 0.04 respectively, p < 0.05) in comparison with the enalapril/amlodipine RI value (0.57 ± 0.03) at 3 months. Moreover, after 3 months of treatment, a significant decrease (by -5.47 bursts/min) (p < 0.05) in muscle sympathetic nerve activity was observed in the lercanidipine/enalapril group (50.79 ± 6.49) compared with baseline (56.26 ± 6.05), while no differences were detected in the amlodipine/enalapril and hydrochlorothiazide/enalapril groups. Conclusions: Our study provides evidence of the efficacy of the lercanidipine/enalapril combination in ameliorating hypertension-related target organ damage and in reducing sympathetic overdrive.

PREVALENCE, CHARACTERISTICS AND PREDICTIVE VALUE OF SEVERE RESISTANT HYPERTENSION FOR THE INCIDENCE OF CARDIOVASCULAR DISEASE

Results: The incidence of the composite end-point was 6.7% (156 patients) over the whole follow-up period [(61 patients with CAD, 21 patients with stroke, 78 patients with AF (44 paroxysmal and 34 permanent forms) and 16 with more than one event]. The prevalence of RH was 7.9%. Patients with severe RH compared to those without were older (by 4.4 years, p<0.001) and exhibited greater waist circumference (by 4.4 cm, p<0.001), body mass index (by 1 kg/m2, p=0.001) and prevalence of diabetes (by 7%, p=0.006), as well as increased left ventricular mass index (by 14.2 g/m2, p<0.001), glucose (by 10.2 mg/dl, p<0.001), creatinine (by 0.11 mg/dl, p=0.001) and triglycerides levels (by 25.2 mg/dl, p<0.001) and decreased potassium (by 0.11 meq/L, p=0.002) and HDL levels (by 2.2 mg/dl, p=0.038). Incidence of CAD (5.4% vs. 2.4%, log rank p=0.013), stroke (2.7% vs. 0.7%, log rank p=0.006), AF (7.1% vs. 3%, log rank p=0.004) and their composite (13% vs. 6.2%, log rank p<0.001) was signiicantly higher in patients with RH. By applying multivariate Cox regression analysis the presence of RH (HR 1.66, p=0.037) along with age (HR=1.059, p<0.001), male gender (HR 2.154, p<0.001) and smoking (HR=1.804, p=0.003) were independently associated with the incidence of the composite end-point. Conclusions: The presence of severe ofice RH among all traditional risk factors turned out to be a potent independent predictor of advanced cardiovascular disease in the setting of essential hypertension.

Role of PCSK9 inhibitors in high risk patients with dyslipidemia: Focus on familial hypercholesterolemia

BACKGROUND Familial hypercholesterolemia (FH) is an inherited autosomal dominant disorder that is characterized by substantially increased Low-Density Lipoprotein Cholesterol (LDL-C) levels. Patients with FH have a significantly higher risk for Cardiovascular (CV) events, and the timely reduction of LDL-C is of paramount importance to ameliorate the risk for CV disease. Among the available lipid-lowering therapies, the novel Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) inhibitors have emerged as a very promising class of drugs for the management of such patients. OBJECTIVE The purpose of this review is to present available data on the efficacy and safety of the two available PCSK9 inhibitors in patients with FH, and importantly to discuss potential differences between the two drugs. METHODS A comprehensive literature search was performed to identify available data from clinical studies evaluating the impact of evolocumab or alirocumab on lipid and CV parameters in patients with FH. RESULTS Several studies have assessed the lipid-lowering profile of PCSK9 inhibitors in patients with FH. Both evolocumab and alirocumab were found to significantly reduce LDL-C by more than 50-60% in FH patients. Furthermore, data also support a lower rate of lipid apheresis in FH patients receiving a PCSK9 inhibitor. In terms of CV outcomes, both drugs were found to possess CV-ameliorating effects of the same extent in patients with CV disease. However, alirocumab reduced all-cause mortality, as well, a finding not observed with evolocumab. Several differences in the study population characteristics might explain this and other mild differences observed in the CV trials of these drugs. CONCLUSION Available evidence suggests similar potency of alirocumab and evolocumab in reducing lipids and CV events.

Human Immunodeficiency Virus Infection And Hypertension. Is There a Connection

Data support that hypertension (HTN) is prevalent among human immunodeficiency virus (HIV) patients contributing to increased risk of cardiovascular disease. Immunodeficiency and prolonged antiretroviral treatment along with common risk factors including older age, male gender, and high body mass index might conduce to greater incidence of HTN. The purpose of this review was to summarize recent evidence of the increased cardiovascular risk in these patents linking HIV infection to HTN.