Arterial hypertension is a major risk factor for atherosclerosis. The mechanisms involved include elevation of blood pressure, increased velocity of the sphygmic wave and increased blood flow turbulence. These hemodynamic features however do not fully explain the link between hypertension and atherosclerosis. An important role is also played by humoral factors including catecholamines, the renin-angiotensin-aldosterone system, serotonin, endothelin, platelets and endothelium-derived growth factors. Furthermore in the last few years great relevance has been attributed to hyperinsulinemia (accompanied by hypercholesterolemia and hypertriglyceridemia) that is frequently found in hypertensive subjects. Several recent reports on the antiatherogenic effect of some antihypertensive agents that could slow down the progression of atherosclerotic lesions in hypertensive subjects are promising.
The World Heart Federation is the new name of the International Society and Federation of Cardiology (ISFC), as approved by the General Assembly, which met during the World Congress of Cardiology in Rio de Janeiro, Brazil, in April 1998. The organization was formed in 1978 by a merger of the International Society of Cardiology (a professional organization founded in 1946, with a worldwide membership of national societies of cardiology) and the International Cardiology Federation (an association of heart foundations set up in 1970 to promote fund-raising for research, professional, and public education and community programs). The new World Heart Federation therefore has >50 years’ experience fighting heart disease throughout the world. At present, it brings together national societies of cardiology and heart foundations from 81 countries, as well as “continental” members covering the Asia-Pacific region, Europe, the Americas, and Africa. In recent years, the World Heart Federation has worked in 2 ways: (1) through its scientific councils, which are engaged in many projects, some of them with the World Health Organization (WHO); and (2) through its heart foundations, now grouped in continental associations, which are very active in public education relating to all aspects of heart health. The fight against tobacco use is 1 important aim of our organization. Very recently, the World Heart Federation has taken a firm position against any settlement with the tobacco companies proposed by the United States of America, which does not give equal treatment to citizens of the United States and citizens of other countries. Heart foundations provide a way for laypeople, many of them affected directly or indirectly by heart disease and stroke, to contribute to the fight against cardiovascular diseases, mainly by adapting the knowledge gained from research and medical practice into health education programs for the public. We are convinced that …
It gets more and more frequent to use oxygen consumption (VO2) to evaluate exercise capacity and response to treatment in heart failure patients. The amount of VO2 is due to ventilation, oxygen transport and muscle activity. No one of these single steps can define by itself VO2, but all these physiological functions are integrated each other. In this paper we examine the modifications of cardiac output, arteriovenous oxygen content difference, and the temporal behavior of their variations during exercise in heart failure. We specifically describe changes in VO2 during simulated altitude; we also contemplate mechanisms governing oxygen diffusion from capillary bed to mitochondria and critical capillary PO2 concept.
Coronary flow reserve assessed by transthoracic harmonic Doppler gives concordant results with SPECT perfusion scintigraphy. The diagnostic potential of SPECT may be increased by the noninvasive assessment of coronary flow reserve in the left anterior descending coronary artery.
Several trials performed in elderly patients have demonstrated that antihypertensive drugs are effective in both systo-diastolic and isolated systolic hypertension, reducing the incidence of fatal and nonfatal cardiovascular events. However because of technical and design problems, the studies carried out to date have involved highly selected patients, almost always without any target organ damage, independent, cognitively normal and with low comorbidity. Therefore, trial results may be transferred to clinical practice only with some caution. Therapeutic behavior could be different in the presence of diseases associated with hypertension: a) in case of associated specific cardiovascular complications and/or diseases, such as diabetes or dyslipidemia, which could increase cardiovascular risk, treatment must be more aggressive; b) in case of associated diseases with fatal prognosis, treatment is aimed at preventing hypertensive emergencies; c) in case of associated diseases, which are not life-threatening but require chronic pharmacological intervention, drug interaction must be carefully considered. Finally, sudden and significant blood pressure drops due both to overdosage of antihypertensive drugs and/or to intercurrent illnesses must be prevented, because the reduction of blood flow may induce severe target organ ischemia.
Approximately 50% of patients with peripheral vascular disease have severe coronary artery disease. Several ways of predicting the postoperative risk of major cardiac events in peripheral vascular patients have been suggested. Among preoperative tests, echocardiography is now receiving greater favor for risk stratification.
Abdominal aortic aneurysms are common in the aging population; their surgical treatment is well established and allows good results in specialized centers. Endovascular exclusion of abdominal aortic aneurysms has been shown to be feasible since 1991 and nowadays commercially available bifurcated endografts allow safe exclusion in selected cases. In the last year 22 patients with an aorto-iliac aneurysm received endovascular treatment at our Institution. We included patients with favorable anatomic characteristics (i.e. neck > 15 mm length, and < 28 mm diameter, iliac neck < 12 mm diameter, absence of > 90 degrees iliac or aortic angulation) and, in particular, those with increased surgical risk for systemic pathology (12 patients), or hostile abdomen (9 patients). We employed Vanguard II (Boston Scientific) endovascular grafts introduced through a surgically exposed common femoral artery; the contralateral limb of bifurcated grafts was inserted percutaneously. The endograft was successfully implanted in all cases, requiring additional iliac cuffs for complete aneurysm exclusion in 3 cases. Periprocedural morbidity included one case of thrombosis and one case of pseudoaneurysm of the punctured femoral artery, which required surgical treatment. In one case surgical exposure of the iliac artery was required in order to advance the device into the aorta. In one patient who previously underwent hemicolectomy, postoperative colonic ischemia was observed, and pharmacological treatment was required. Moreover we also observed one case of groin infection that was treated successfully with local wound care and systemic antibiotics, and one late contralateral limb thrombosis that was successfully treated with loco-regional thrombolysis. The mean follow-up was 6.1 months: one patient died because of congestive heart failure. No further morbidity was recorded. A type-II endoleak was observed in one patient, originating from the inferior mesenteric artery with no sac enlargement; this patient is still under observation. In conclusion, with proper clinical selection, commercially available endovascular devices allow safe exclusion of abdominal aortic aneurysms. Long-term follow-up is needed to ascertain the durability of the procedure.
Directional coronary atherectomy (DCA) was introduced as a new percutaneous revascularization modality in 1990, and was initially applied to large vessels without tortuosity or calcification, with overall results including a 95% procedural success, 94% clinical success and 4.6% major complications (urgent bypass surgery in 3.8%, Q wave myocardial infarction in 1.7%, and hospital mortality in 0.3% of patients). In addition to its established efficacy for eccentric lesions, newer applications emerged such as treatment of saphenous vein grafts, thrombus-associated lesions, aorto-ostial lesions, failed or suboptional coronary angioplasty results, bifurcation lesions and use as a part of multi-vessel intervention. Comparative studies with coronary angioplasty such as CAVEAT I and II and CCAT showed better success rates with DCA vs coronary angioplasty, but failed to demonstrate benefit in restenosis rates. OARS and BOAT studies helped define optimal atherectomy techniques, which led to better acute angiographic results and to the "debulking plus stenting" concept. A spin-off of those clinical applications has been the opportunity to study the histology of tissue excised by DCA in vivo in different clinical settings. Such studies, investigating plaque ulceration, thrombosis and inflammation are reviewed, with special emphasis on new insights into unstable angina; the future of atherectomy research is also outlined with a categorization of various possible protocols to be applied utilizing coronary atherectomy specimens from live patients.
Chapter 18Token Access Soluble Adhesion Molecules as in vivo Biohumoral Markers of Vascular Cell Activation Jacopo Gianetti MD, PhD, Jacopo Gianetti MD, PhDSearch for more papers by this authorRaffaele De Caterina MD, PhD, Raffaele De Caterina MD, PhDSearch for more papers by this author Jacopo Gianetti MD, PhD, Jacopo Gianetti MD, PhDSearch for more papers by this authorRaffaele De Caterina MD, PhD, Raffaele De Caterina MD, PhDSearch for more papers by this author Book Editor(s):Raffaele De Caterina MD, PhD, Raffaele De Caterina MD, PhD Professor of Cardiology, Chair and Postgraduate School of Cardiology; “G. d'Annunzio” University - Chieti, Ospedale San Camillo de Lellis; Via C. Forlanni, 50, 66100 Chieti Director, Laboratory for Thrombosis and Vascular Research; CNR Institute of Clinical Physiology, Area della Ricerca di S. Cataldo; Via G.Moruzzi, 1, 56124 Pisa, ItalySearch for more papers by this authorPeter Libby MD, Peter Libby MD Mallinckrodt Professor, Harvard Medical School and Chief, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USASearch for more papers by this author First published: 01 January 2007 https://doi.org/10.1002/9780470988473.ch18Citations: 1 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Summary This chapter contains sections titled: Adhesion molecules Immunoglobulins Role of cell adhesion molecules in atherogenesis and inflammation (see also Chapters 1 and 2) Soluble adhesion molecules: nature, potential mechanisms of regulation of the membrane release and pathophysiological role Soluble adhesion molecules in clinical settings Areas of clinical investigation and future perspectives Citing Literature Endothelial Dysfunctions in Vascular Disease RelatedInformation
