Miklós Krepuska

Serum level of soluble Hsp70 is associated with vascular calcification

It has been previously reported that serum levels of 70-kDa heat shock protein (Hsp70) are elevated in peripheral artery disease. The aim of the present study was to examine whether increased serum Hsp70 levels are related to the extent of arterial calcification and standard laboratory parameters of patients with peripheral artery disease, as well as to markers of inflammation (C-reactive protein), atherosclerosis (homocysteine), and calcification (fetuin-a). One hundred eighty chronic atherosclerotic patients with significant carotid stenosis and/or lower extremity vascular disease were enrolled in this cross-sectional study. Systemic atherosclerosis and calcification was assessed by ultrasound (carotid intima–media thickness (IMT), presence of calcification at the abdominal aorta, carotid and femoral bifurcations, and aortic and mitral cardiac valves). Standard serum markers of inflammation, diabetes, renal function, ankle-brachial indexes, and traditional risk factors for atherosclerosis were noted. Serum Hsp70 levels were measured with enzyme-linked immunosorbent assay. Standard laboratory parameters (clinical chemistry), C-reactive protein (CRP), and homocysteine levels were determined by an autoanalyzer using the manufacturer’s kits. Fetuin-a levels were measured by radial immunodiffusion. Patients’ median age was 64 (57–71) years, 69% were men, and 34.5% had diabetes. Serum heat shock protein 70 levels were significantly higher in patients with more severe arterial calcification (p < 0.02) and showed significant positive correlations with serum bilirubin (r = 0.23, p = 0.002) and homocysteine levels (r = 0.18, p = 0.02). Serum Hsp70 did not correlate with body mass index, IMT, CRP, or fetuin-a levels in this cohort. Logistic regression analysis confirmed the association between sHsp70 and calcification score (OR, 2.189; CI, 1.156–4.144, p = 0.016) and this correlation remained significant (OR, 2.264; CI, 1.021–5.020, p = 0.044) after the adjustment for age, sex, eGFR, smoking, CRP, and homocysteine levels. Our data show that serum Hsp70 levels correlate with the severity of atherosclerosis in patients with carotid artery disease and chronic lower limb ischemia. These data support a putative role for plasma Hsp70 in the development of arterial calcification. Nevertheless, further studies are required to investigate the usefulness of circulating Hsp70 level as a marker of atherosclerotic calcification.

Plasma nociceptin/orphanin FQ levels are lower in patients with chronic ischemic cardiovascular diseases--A pilot study.

BACKGROUND Clinical studies are limited regarding the role of human nociceptin/orphanin FQ (N/OFQ) in ischemic cardiovascular diseases, which are still the number one cause of death in the developed world. The aim of our study was to measure the plasma levels of N/OFQ in patients with chronic ischemic cardiovascular diseases in a pilot study. METHODS AND RESULTS Our study population consisted of 22 patients presenting symptoms of stable angina pectoris (SAP): 12 severe Canadian Cardiovascular Society (CCS) III-IV functional class, and 10 with milder SAP (CCS II-III). 12 patients were also enrolled with chronic peripheral artery disease (9 with intermittent claudication; 3 with rest pain and gangrene). Patients were asked to avoid any exertion or given analgetics for their rest pain. Patients had no episodes of chest or limb pain in 1week before their fasting blood samples were taken and N/OFQ plasma levels were measured by radioimmunoassay. 14 healthy subjects without any cardiac risk factors served as a control group. CONCLUSIONS N/OFQ levels were significantly lower in patient groups with severe vs. milder chronic angina (p<0.05) and vs. control subjects (p<0.01). Patients suffering from peripheral artery disease had also a lower plasma N/OFQ levels than in healthy controls (p<0.01). Our findings show that chronic ischemic conditions of atherosclerotic origin are associated with significantly lower plasma N/OFQ levels.

Decreased plasma nociceptin/orphanin FQ levels after acute coronary syndromes

Foregoing researches made on the N/OFQ system brought up a possible role for this system in cardiovascular regulation. In this study we examined how N/OFQ levels of the blood plasma changed in acute cardiovascular diseases. Three cardiac patient groups were created: enzyme positive acute coronary syndrome (EPACS, n = 10), enzyme negative ACS (ENACS, n = 7) and ischemic heart disease (IHD, n = 11). We compared the patients to healthy control subjects (n = 31). We found significantly lower N/OFQ levels in the EPACS [6.86 (6.21-7.38) pg/ml], ENACS [6.97 (6.87-7.01) pg/ml and IHD groups [7.58 (7.23-8.20) pg/ml] compared to the control group [8.86 (7.27-9.83) pg/ml]. A significant correlation was detected between N/OFQ and white blood cell count (WBC), platelet count (PLT), creatine kinase (CK), glutamate oxaloacetate transaminase (GOT) and cholesterol levels in the EPACS group.Decreased plasma N/OFQ is closely associated with the presence of acute cardiovascular disease, and the severity of symptoms has a significant negative correlation with the N/OFQ levels. We believe that the rate of N/OFQ depression is in association with the level of ischemic stress and the following inflammatory response. Further investigations are needed to clarify the relevance and elucidate the exact effects of the ischemic stress on the N/OFQ system.

Fetuin-A serum levels in patients with aortic aneurysms of Marfan syndrome and atherosclerosis.

Eur J Clin Invest 2011; 41 (2): 176–182

Prevalence of osteoporosis in patients with severe peripheral artery disease

INTRODUCTION Recent studies highlighted a significant association between bone mineral density and atherosclerosis. Cardiovascular disease is the main cause of death in Western countries, while the prevalence of osteoporosis reached 9% in Hungary. AIM The aim of this study was to investigate the prevalence of osteoporosis among patients with peripheral vascular disease. METHODS In a cross-sectional study bone mineral density using dual-energy X-ray absorptiometry in 172 patients with lower limb ischemia was investigated. According to previous medical history and blood tests, risk factors of atherosclerosis were also assessed and serum markers of bone turnover and other factors that could influence osteoporosis were evaluated. RESULTS Prior to bone mineral density screening, osteoporosis was known in 9% of patients. Based on osteodensitometric evaluation, 37% of the patients were diagnosed as having osteopenia and 31% as having osteoporosis. According to risk factors, different patient groups were created. Significantly more female than male patients had osteoporosis, while smoking, age and body mass index failed to affect the prevalence of osteoporosis. CONCLUSION These results suggest that patients with severe atherosclerosis need to be regularly screened and, if necessary, treated for osteoporosis.

[Surgical treatment of acute type-B aortic dissection associated with cocaine use].

UNLABELLED Cocaine abuse is on a rise in Hungary as well. It is known that cocaine users have a higher risk developing cardiovascular complications, for example aortic dissection. Almost all patients in Hungary suffering from type B aortic dissection are referred to our department for treatment. AIM We introduce the case of a regular cocaine user, who suffered an acute type B aortic dissection and was treated surgically. To our best knowledge this is the first similar case in our country to be published. METHOD Case presentation. RESULTS We performed a successful operation: acute thoracoabdominal aortic refenestration, no complication was detected. The patient is doing well three months after the procedure, returned to his regular activities, he is normotensively receiving medical treatment, and he gave up cocaine. CONCLUSIONS Thoracoabdominal aortic refenestration can save the life of patients presenting with acute type B dissection. Good long-term result depends on adequate hypertension control and cocaine abstinence. As the frequency of cocaine abuse increases in Hungary, similar cases may be more often encountered.A kokainfogyasztas gyakorisaga Magyarorszagon is novekszik. E drog hasznalata fokozott kockazatot jelent sziv- es errendszeri betegsegek kialakulasa, peldaul aortadissectio szempontjabol. Klinikankon zajlik hazankban a B tipusu aortadissectios betegek dontő tobbsegenek ellatasa. Celkitűzes: Egy rendszeresen kokaint hasznalo, akut B tipusu aortadissectiot elszenvedett beteg műteti kezeleset mutatjuk be esetismertetesunkben, amely tudomasunk szerint az első hasonlo eset hazankban. Modszer: Esetleiras. Eredmenyek: Egy 35 eves ferfi erős, mellkasi-hati-derektaji fajdalmak miatt előszor a gerincsebeszeti osztalyhoz fordult, majd kiugroan magas vernyomasertekek miatt belgyogyaszati osztalyra helyeztek at. A B tipusu aortadissectio diagnozisat CT-angiographia igazolta, a beteg ersebeszeti centrumba kerult, ahol sikeres műtetet, thoracoabdominalis aortarefenesztraciot vegeztunk. A beteg 3 honappal a műtet utan jol van, antihipertenziv szerek szedese mellett mindennapi feladatait ellatja, szovődmenyt nem eszleltunk, a kokainrol leszokott. Kovetkeztetesek: Az akut B tipusu dissectio sebeszi ellatasa megmentheti a beteg eletet. A hosszu tavu eredmenyes kezelesben a hipertonia kontrollja mellett a kokainrol tortenő leszokas alapvető jelentősegű. Hasonlo esetek előfordulasara a kokainfogyasztas novekedese eseten hazankban is szamithatunk.

Hemodynamic Effects of the Light Stabilizer Tinuvin 770 in Dogs In Vivo

Introduction: Tinuvin 770 [bis(2,2,6,6-tetramethyl-4-piperidinyl) sebacate, Ciba-Geigy, Basel, Switzerland] is a UV light stabilizer that is a component of many plastic materials used world-wide in the medical and food industries. We report on the acute hemodynamic effects of Tinuvin 770 examined in dogs. Materials and Methods: Tinuvin 770 was dissolved in a mixture of saline and ethanol (1:1 v/v) and was administered to 12 intravenously narcotized and respirated dogs in increasing doses (T1-T7: 1, 3.3, 6.6, 10, 33.3, 66.6 and 100 mg, respectively). The doses were given as bolus injections over a three minute period, and the effects were recorded for 12 minutes. The vehicle was used as a control. Hemodynamic parameters (heart rate, blood pressure, end-diastolic pressure, dp/dt, cardiac output) and ECG were monitored continously. Results: At doses T1-T4, systolic and diastolic blood pressures, mean pressure and ventricular contractility were significantly decreased without significant changes in cardiac output, heart rate, or PQ interval. At doses T5 and T6, declines in blood pressure and myocardial contractility were observed. At doses T6 and T7, heart rate and PQ interval decreased substantially. Irreversible circulatory failure occured in one dog after administering dose T6 and in 8 dogs following dose T7. Conclusion: Tinuvin 770 induces acute hemodynamic alterations. In lower doses, it causes peripheral vasodilatation, however at higher doses acute cardiac failure occured. Plastics containing Tinuvin 770 should be used with care in medical practice and the laboratory.

B típusú aortadissectio sebészi kezelése kokaint használó beteg esetében@@@Surgical treatment of acute type B aortic dissection associated with use of cocaine

UNLABELLED Cocaine abuse is on a rise in Hungary as well. It is known that cocaine users have a higher risk developing cardiovascular complications, for example aortic dissection. Almost all patients in Hungary suffering from type B aortic dissection are referred to our department for treatment. AIM We introduce the case of a regular cocaine user, who suffered an acute type B aortic dissection and was treated surgically. To our best knowledge this is the first similar case in our country to be published. METHOD Case presentation. RESULTS We performed a successful operation: acute thoracoabdominal aortic refenestration, no complication was detected. The patient is doing well three months after the procedure, returned to his regular activities, he is normotensively receiving medical treatment, and he gave up cocaine. CONCLUSIONS Thoracoabdominal aortic refenestration can save the life of patients presenting with acute type B dissection. Good long-term result depends on adequate hypertension control and cocaine abstinence. As the frequency of cocaine abuse increases in Hungary, similar cases may be more often encountered.A kokainfogyasztas gyakorisaga Magyarorszagon is novekszik. E drog hasznalata fokozott kockazatot jelent sziv- es errendszeri betegsegek kialakulasa, peldaul aortadissectio szempontjabol. Klinikankon zajlik hazankban a B tipusu aortadissectios betegek dontő tobbsegenek ellatasa. Celkitűzes: Egy rendszeresen kokaint hasznalo, akut B tipusu aortadissectiot elszenvedett beteg műteti kezeleset mutatjuk be esetismertetesunkben, amely tudomasunk szerint az első hasonlo eset hazankban. Modszer: Esetleiras. Eredmenyek: Egy 35 eves ferfi erős, mellkasi-hati-derektaji fajdalmak miatt előszor a gerincsebeszeti osztalyhoz fordult, majd kiugroan magas vernyomasertekek miatt belgyogyaszati osztalyra helyeztek at. A B tipusu aortadissectio diagnozisat CT-angiographia igazolta, a beteg ersebeszeti centrumba kerult, ahol sikeres műtetet, thoracoabdominalis aortarefenesztraciot vegeztunk. A beteg 3 honappal a műtet utan jol van, antihipertenziv szerek szedese mellett mindennapi feladatait ellatja, szovődmenyt nem eszleltunk, a kokainrol leszokott. Kovetkeztetesek: Az akut B tipusu dissectio sebeszi ellatasa megmentheti a beteg eletet. A hosszu tavu eredmenyes kezelesben a hipertonia kontrollja mellett a kokainrol tortenő leszokas alapvető jelentősegű. Hasonlo esetek előfordulasara a kokainfogyasztas novekedese eseten hazankban is szamithatunk.

Surgical treatment of acute type B aortic dissection associated with use of cocaine

UNLABELLED Cocaine abuse is on a rise in Hungary as well. It is known that cocaine users have a higher risk developing cardiovascular complications, for example aortic dissection. Almost all patients in Hungary suffering from type B aortic dissection are referred to our department for treatment. AIM We introduce the case of a regular cocaine user, who suffered an acute type B aortic dissection and was treated surgically. To our best knowledge this is the first similar case in our country to be published. METHOD Case presentation. RESULTS We performed a successful operation: acute thoracoabdominal aortic refenestration, no complication was detected. The patient is doing well three months after the procedure, returned to his regular activities, he is normotensively receiving medical treatment, and he gave up cocaine. CONCLUSIONS Thoracoabdominal aortic refenestration can save the life of patients presenting with acute type B dissection. Good long-term result depends on adequate hypertension control and cocaine abstinence. As the frequency of cocaine abuse increases in Hungary, similar cases may be more often encountered.A kokainfogyasztas gyakorisaga Magyarorszagon is novekszik. E drog hasznalata fokozott kockazatot jelent sziv- es errendszeri betegsegek kialakulasa, peldaul aortadissectio szempontjabol. Klinikankon zajlik hazankban a B tipusu aortadissectios betegek dontő tobbsegenek ellatasa. Celkitűzes: Egy rendszeresen kokaint hasznalo, akut B tipusu aortadissectiot elszenvedett beteg műteti kezeleset mutatjuk be esetismertetesunkben, amely tudomasunk szerint az első hasonlo eset hazankban. Modszer: Esetleiras. Eredmenyek: Egy 35 eves ferfi erős, mellkasi-hati-derektaji fajdalmak miatt előszor a gerincsebeszeti osztalyhoz fordult, majd kiugroan magas vernyomasertekek miatt belgyogyaszati osztalyra helyeztek at. A B tipusu aortadissectio diagnozisat CT-angiographia igazolta, a beteg ersebeszeti centrumba kerult, ahol sikeres műtetet, thoracoabdominalis aortarefenesztraciot vegeztunk. A beteg 3 honappal a műtet utan jol van, antihipertenziv szerek szedese mellett mindennapi feladatait ellatja, szovődmenyt nem eszleltunk, a kokainrol leszokott. Kovetkeztetesek: Az akut B tipusu dissectio sebeszi ellatasa megmentheti a beteg eletet. A hosszu tavu eredmenyes kezelesben a hipertonia kontrollja mellett a kokainrol tortenő leszokas alapvető jelentősegű. Hasonlo esetek előfordulasara a kokainfogyasztas novekedese eseten hazankban is szamithatunk.