Wolfgang Mlekusch

Joint Effects of C-Reactive Protein and Glycated Hemoglobin in Predicting Future Cardiovascular Events of Patients With Advanced Atherosclerosis

Background—C-reactive protein (CRP) and glycohemoglobin (HbA1c) are established risk factors for the development of cardiovascular disease. We investigated the joint effects of these parameters on cardiovascular outcome of patients with advanced atherosclerosis. Methods and Results—We studied 454 patients with advanced atherosclerosis (median age, 69 years; 264 male). Cardiovascular risk profile, high-sensitivity CRP (hs-CRP), and HbA1c were obtained at baseline, and patients were followed for a median of 21 months (interquartile range, 13 to 26) for the occurrence of major adverse cardiovascular events (MACE) (myocardial infarction, percutaneous coronary interventions, coronary artery bypass graft, carotid revascularization, stroke, and death). We observed 166 MACE in 128 patients (28%). Cumulative event-free survival rates at 6, 12, and 24 months were 91%, 85%, and 73%, respectively. Adjusted hazard ratios for the occurrence of MACE according to increasing quartiles of hs-CRP and HbA1c were 1.35 (P =0.31), 1.90 (P =0.026) and 2.13 (P =0.007), and 1.40 (P =0.26), 1.81 (P =0.059), and 2.36 (P =0.023), respectively, compared with the lowest quartiles. Considering both parameters jointly, we found that patients with hs-CRP >0.44 mg/dL and HbA1c >6.2% (upper quartiles) were at highest risk for MACE, with each parameter adding to the prognostic information of the other. Conclusions—Inflammation, indicated by hs-CRP, and hyperglycemia, indicated by HbA1c, jointly contribute to the cardiovascular risk of patients with advanced atherosclerosis. Patients with both hs-CRP and HbA1c in the upper quartiles (>0.44 mg/dL and >6.2%, respectively) are at particularly high risk for poor cardiovascular outcome.

Low Serum Magnesium Predicts Neurological Events in Patients With Advanced Atherosclerosis

Background and Purpose— Magnesium (Mg) deficiency is thought to be a risk factor for cerebrovascular atherosclerosis and complications. We investigated the prognostic impact of Mg serum levels with respect to the occurrence of neurological events in patients with advanced atherosclerosis. Methods— We prospectively studied 323 patients with symptomatic peripheral artery disease and intermittent claudication (197 men; median age, 68 years). Serum Mg was determined, and patients were followed for a median of 20 months (interquartile range, 12 to 25 months) for the occurrence of neurological events, defined as ischemic stroke and/or carotid revascularization (carotid endarterectomy or carotid stenting). Multivariate Cox proportional hazards analysis was applied to assess the association of serum Mg (in tertiles) and neurological events. Results— Neurological events occurred in 35 patients (11%) (15 patients with stroke, 13 with carotid revascularization, and 7 with stroke and subsequent revascularization). Compared with patients in the highest tertile of Mg serum levels (>0.84 mmol/L), patients with Mg serum values <0.76 mmol/L (lowest tertile) exhibited a 3.29-fold increased adjusted risk (95% CI, 1.34 to 7.90; P=0.009) for neurological events, but patients with Mg serum values of 0.76 mmol/L to 0.84 mmol/L (middle tertile) had no increased risk (adjusted hazard ratio, 1.10; 95% CI, 0.35 to 3.33; P=0.88). Mg serum levels were not associated with all-cause mortality (P=0.87) or coronary events (P=0.67) during follow-up. Conclusions— Low Mg serum levels indicate an increased risk for neurological events in patients with symptomatic peripheral artery disease, favoring Mg substitution therapy in those patients with advanced atherosclerosis.

Haem oxygenase‐1 genotype and cardiovascular adverse events in patients with peripheral artery disease

Backgroundu2002 A functional GT dinucleotide length polymorphism in the haem oxygenase‐1 (HO‐1) gene promoter is thought to be involved in the pathogenesis of cardiovascular disease. Short (< 25) (GT)n repeats are suggested to facilitate enhanced HO‐1 up‐regulation in response to injury and confer potent anti‐inflammatory and antioxidative effects.

Correlation of infrared thermography and skin perfusion in Raynaud patients and in healthy controls.

BACKGROUNDnWe aimed to investigate the correlation of infrared thermography (IT) with laser Doppler perfusion imager (LDPI) among patients with primary Raynauds phenomenon and healthy controls.nnnMETHODSnForty-seven individuals were included: we examined 25 patients with primary Raynauds phenomenon and 22 age and gender matched healthy controls. IT of the volar surface of the subjects left hands was performed to record skin temperature while skin perfusion of the same area was determined using LDPI. All measurements were obtained at room temperature (baseline measurements) and following standardized cold provocation.nnnRESULTSnGood correlation of baseline measurements was found between IT and LDPI in primary Raynaud patients and healthy controls (r=0.868, p<0.0001 vs. r=0.790, p<0.0001). Following cold challenge, correlation was weaker in both groups (r=0.742 vs. r=0.766, p<0.0001). Correlation after cold provocation was statistically significant among patients with primary Raynauds phenomenon in contrast to controls (Chi Quadrat, p=0.023 vs. p=0.306).nnnCONCLUSIONnA significant correlation was found between IT and LDPI in primary Raynaud patients and in healthy controls (r=0.868 and r=0.742, both p<0.0001). Following cold provocation, correlation decreases in both groups. Thus, at room temperature IT might substitute for skin perfusion measured by LDPI.

Arterial Puncture Site Management after Percutaneous Transluminal Procedures Using a Hemostatic Wound Dressing (Clo-Sur P.A.D.) versus Conventional Manual Compression: A Randomized Controlled Trial:

Purpose: To investigate the efficacy and safety of a novel hemostatic wound dressing designed for rapid hemostasis at arterial puncture sites. Methods: Over a 15-month period, 209 consecutive patients were randomized to conventional manual compression (n = 105) or the use of the Clo-Sur P.A.D. hemostatic device (n = 104) after removal of the sheath. Puncture-related and device-related complications, time to hemostasis, time to ambulation, and patient and physician discomfort were recorded. Results: In 209 patients, 21 (10.0%) puncture-related complications were observed, including 11 (5.3%) pseudoaneurysms, 9 (4.3%) hematomas, and 1 (0.5%) major bleeding complication. There was no significant difference (p=0.36) in complications between the hemostatic device (9/104, 8.7%) and the conventional group (12/105, 11.4%). In the hemostatic device group compared to the conventional group, respectively, the average time to hemostasis (13.6 versus 20.3 minutes; p<0.001), time to ambulation (6.5 versus 17.4 hours, p<0.001), patient discomfort (VAS 2.1 versus 4.7, p<0.001), and physician discomfort (VAS 3.8 versus 5.2, p<0.001) were significantly lower. Twenty (19%) sheath removals in the hemostatic device group were classified as a technical failure of the device. Conclusion: The use of this hemostatic wound dressing for arterial access site management after percutaneous vascular procedures significantly reduced the time to hemostasis, enabled early mobilization, and reduced patient discomfort without increasing the risk for complications compared to conventional manual compression. A high rate of technical failures, however, warrants further improvement before routine use can be recommended.

Outcome after endovascular treatment of deep femoral artery stenosis: results in a consecutive patient series and systematic review of the literature.

Purpose: To evaluate immediate and midterm clinical outcomes after percutaneous transluminal angioplasty (PTA) of deep femoral artery stenosis in patients with chronically occluded superficial femoral arteries (SFA) and to report the results of a systematic review of the literature in this field. Methods: A retrospective analysis was conducted of 55 consecutive patients (42 men; median age 72 years, interquartile range [IQR] 63–79) with severe intermittent claudication (n=38) or critical limb ischemia (n = 17) who underwent balloon angioplasty of deep femoral artery stenosis. Patients were followed with ankle-brachial index (ABI) measurement, estimation of maximum walking capacity, clinical staging of peripheral artery disease (PAD), and duplex ultrasound imaging for restenosis. A systematic review of the literature using MEDLINE, EMBASE, and a hand search was done. Results: Technical success (residual stenosis <30%) was achieved in 85% (47/55), with 1 (2%) minor complication. The median ABI marginally increased from 0.48 at baseline to 0.53 post intervention without significant difference in the change of ABI between patients with supra- or infragenicular reconstitution of the femoropopliteal runoff. During a median 13-month (IQR 3–42) follow-up, no significant improvement in ABI or walking distance was maintained, and only 16 (29%) patients reported a sustained clinical improvement by 1 PAD stage. Cumulative patency and reintervention-free survival rates were, respectively, 71% and 61% at 1 year and 49% and 48% at 3 years. In the literature, only case series were found, but no randomized trial evaluating the efficacy of deep femoral artery PTA. Conclusion: PTA of the deep femoral artery can be performed with high technical success rates at a low interventional risk. However, in the majority of patients, this technique yields no sustained hemodynamic or clinical benefit. Due to a high rate of late failures, it should be reserved for limb salvage in patients without a surgical alternative.

Renal artery stenosis predicts adverse cardiovascular and renal outcome in patients with peripheral artery disease

Backgroundu2002 Patients with symptomatic peripheral artery disease (PAD) are considered cardiovascular high‐risk patients. Our aim was to investigate whether incidental renal artery stenosis (RAS) increases the risk for adverse cardiovascular and renal outcomes in these patients.

Influence and interaction of diabetes and lipoprotein (a) serum levels on mortality of patients with peripheral artery disease.

Backgroundu2002 Diabetes mellitus is a risk factor for early complications and mortality in patients with peripheral artery disease. Lipoprotein (a) [Lp(a)] is also suggested to be a marker of increased cardiovascular risk. We investigated the association and interaction between diabetes mellitus, lipoprotein(a) and mortality in high risk patients with peripheral artery disease (PAD).

Auricular electroacupuncture reduces frequency and severity of Raynaud attacks

ZusammenfassungFRAGESTELLUNG: Es konnte gezeigt werden, dass Akupunktur potenziell die Hautperfusion sowie die subjektive Kältewahrnehmung beeinflusst. Unsere Hypothese ist daher, dass aurikuläre Elektroakupunktur (EA) bei primärem Raynaud Phänomen (PRP) eine Symptomreduktion bewirken kann. METHODE: Sechsundzwanzig Patienten mit PRP erhielten 6 Zyklen aurikuläre EA. Nach 3, 6 und 24 Wochen wurden Häufigkeit und Schweregrad der Raynaud-Attacken mittels standardisierter Fragebögen und visueller Analogskalen (VAS) evaluiert. Weiters wurden die Hauttemperatur mit Infrarotthermographie und die Hautperfusion mit einem Laser Doppler Perfusion Imager untersucht. ERGEBNISSE: Verglichen mit den Ausgangswerten fanden wir eine signifikante Reduktion der Attackenhäufigkeit nach 3 (p = 0,001) und 6 Wochen (p < 0,001) aurikulärer EA. Nach 24 Wochen, nach Beendigung der EA, konnte eine anhaltende Verbesserung beobachtet werden (p < 0,001). Weiters konnte eine Reduktion der mit den Attacken assoziierten Schmerzen nach 3 (p = 0,003), 6 (p = 0,003) und 24 Wochen (p = 0,001) aurikulärer EA erreicht werden, während über den Beobachtungszeitraum keine signifikanten Änderungen der Hauttemperatur und der Hautperfusion festgestellt wurden. SCHLUSSFOLGERUNGEN: Aurikuläre EA reduziert Symptome (Häufigkeit und Schweregrad der Attacken), hat jedoch keinen Einfluss auf die Hautperfusion und Hauttemperatur.SummaryBACKGROUND: Acupuncture has been shown to influence skin perfusion and the subjective cold perception threshold. Therefore, we hypothesized that auricular electroacupuncture (EA) might reduce symptoms in primary Raynauds phenomenon (PRP). METHODS: Twenty-six patients with PRP received 6 cycles of auricular EA. After 3, 6 and 24 weeks attack frequency and severity were reevaluated using standardized questionnaires and a visual analogue scale (VAS). Skin temperature was assessed by infrared thermography and laser Doppler perfusion imaging was used to determine skin perfusion. RESULTS: Compared to baseline we found a significant reduction of attack frequency after 3 (p = 0.001) and 6 weeks (p < 0.001) of auricular EA. This improvement sustained following cessation of EA, after 24 weeks (p < 0.001). Furthermore, attack associated pain was reduced after 3 (p = 0.003), 6 (p = 0.003) and 24 weeks (p = 0.001) of treatment, while skin temperature and skin perfusion did not change significantly throughout the study period. CONCLUSIONS: Auricular EA reduces symptoms by means of frequency and severity of attacks in PRP but has no influence on skin perfusion and skin temperature.

Cognitive functions in patients with cerebrovascular disease: potential impact of revascularization

The purpose of this review is to assess the impact of luminal restoring of carotid artery stenosis on cognitive functions. Therefore, papers dealing with the neuropsychological influence of carotid artery stenosis and studies comparing the neuropsychological course after respective recanalization have been included.